The bacillus typhosus is something comparatively new to our generation. Its mark must be traced to the Garden of Eden. Our grand first parents, as Milton calls his version of Adam and Eve, may have named the disease, or worse still, been typhoid carriers It would not have hurt Moses to record the facts about typhoid as carefully as he did leprosy. Mrs. MeWhat thinks maybe the leprosy of those early days was ipso facto, or at least de jure typhoid. Moses' specific, compounded of Shittim and other ingredients, does not sound good to our authorities in this rushing age of specialism.

Recently disputes of international proportions have arisen as to the identity of bovine and human tubercle bacilli. Diseases are modified by habitat. At least Dr. Us says so, and Mrs. McWhat would not know a habitat if she saw its steel engraving; but she thinks she knows how smallpox has a penchant for the belly at times as marked, for instance, as typhoid fever or the product of conception. Rose spots in typhoid indicate involvement of the central nervous system through the circulation; and by reflex action hyperemia of the sweat follicles becomes the handwriting on the skin of peripheral nerve irritation.

In this typhoid rash the hyperemia does not pass further than the second degree; whereas in small-pox rash the congestion reaches the thirty-third degree. Each exanthem is a circumscribed area of inflammation, which ends in gangrene. Several weeks are usually consumed in amputating dead tissue and making the necessary repairs immediately underneath. The pathologic process in the intestine is somewhat analogous. Disorganization of function is produced by the bacillus typhous and its toxin; and these changes are followed by separation of cells from the blood, after death. The final step is aggregation into pus foci.

These technical explanations amounted to deep water to Mrs McWhat, but by the time the learned medical man had veered round to the average man who is slow to get his mind away from the symptoms so that it can be fixed on the proximate cause, she could begin to tread on the granite of self confidence.

The more excellent way to treat typhoid

fever is to use the blood stream as a menstrum in which to dilute an antibody to reinforce nature's lines of battle. Dwarf bacilli are the earliest signs of power exerted by typhoid bacterin. Gradually Samson is shorn of his locks by the therapeutic Delilah. One fine day the process reaches its climax. Temperature suddenly falls and the familiar convalescence from shock and defeverescence is present; but it is uncertain how long the dehorned bacillus may retain lodgment in the blood of its host.

Dr. Us at this juncture felt an irresistible impulse to give Mrs. McWhat a swift kick a posteriori; and the violent exercise afforded to his gastrocnemii muscle caused him to be conscious that he was out in the barn, minus every accoutrement excepting his thermometer. He was trying to stick the bulb into the searchlight which always had such a wonderful effect on his Nellymare, under the somnambulistic impression that it was Jake McWhat's mouth. Jake had no more typhoid fever than a rabbit; and further, he didn't owe Dr. Us a cent. Strange how much control the mind retains over cerebration during the process of sleep walking.

212 Stapleton Block, Billings, Mont.

TYPHOID FEVER, AND GENERAL REMARKS ON VARIOUS SUBJECTS IN DECEMBER SUMMARY.

BY C. W. CANAN, M.D. B.S.

The siege of typhoid fever reported in the December number of THE MEDICAL SUMMARY has come to an end. I am thankful to say that I did not lose a case. But the peculiarity that of the fever running from 30 to 40, and in some cases 56 days before it would break permanently, continued to the last case In spite of all the clean-outs and intestinal antiseptics, many of these patients had fever for 40 to 50 days. I thought before all the patients got well I could perhaps solve the problem, but absolutely failed. Along between the 22d and 30th day, the symptoms would improve and the temperature would decline, often registering normal in the early morning, but would climb up during the day and early night to 100°, and in some cases to 1011⁄2° F. In this way it would run for

days, and even weeks; the patient convalescing all the time. In one case it dropped subnormal and remained there for three days, then gradually followed the line of the other cases. When the temperature left the patient for good it would drop below normal, where it would remain for ten days or two weeks before it would gain the normal.

In one family where there were six cases I had the water boiled, hoping that this would solve the problem, but it made no difference as far as controlling the temperature was concerned.

If the readers have any theories or know why the temperature should behave as recorded, I would be very thankful to have them, that I may be able to meet the condition intelligently should I come across it again.

I desire to give THE SUMMARY readers a short report on the condition of our stout patient, the one I asked for treatment for a few months ago. She has improved in many ways, but is still a long way from being a well woman. The distension of the stomach and bowels is very much better, consequently she is not so short of breath. The vague pains throughout the limbs, back and body that were so distressing have also improved very much. Her constipation, which has been the most obstinate I have ever had anything to do with, has improved also. If you remember, the Editor maped out a line of treatment for this patient. For the constipation he advised giving phenolphthalein in quantity sufficient to act, even if it took as much as four or five grains at a dose to produce mushy stools. I gave it, and continued to give it, until she was taking ten grains every night, and still no mushy stools. I was afraid to go higher, consequently withdrew it. I tried alkaline laxatives, intestinal antiseptics, Robin's strong cascara, Henkle's doublestrength and many others, without results; had always to resort to douches of hot water, glycerin or olive oil, and these had often to be repeated several times before securing the desired result. I have now found a product that is doing the work to perfection, how long it will continue is yet to be

seen.

The product is one containing fringe tree bark and several other agents:

You are going to select a promising location; but let a veteran remind you that the location don't make the successful man. The sine quo nons of success in any field are energy, ambition, studiousness, morality and especially strict sobriety. Many young doctors have met shipwreck on the rocks of intemperance and immorality. Don't get the idea in your head that to curry with the Germans you must drink wine and beer with them, or that you should drink whiskey with the Irish. Even saloonkeepers will not employ a bibulous doctor.

Be dilligent and attentive, but don't overdo the latter by making unnecessary visits. People like interest, soliciture and devotion to the sick, but all that can be practiced without incurring the suspicion that you are piling up an unnecessary bill.

Above all things, cultivate tact, prudence, and don't talk about your patients to the laity, nor from one sick room to another. Doctors, by an unruly tongue, lose business. Keep your counsels to yourself. Don't get the habit of blowing your horn. Let others do that who have wind. Never tell any one that A and B owe you. Let others find it out by experience. Don't, above all things, criticise your brother

doctors, be they old or young. That is one among the meanest and most cowardly acts a man can be guilty of. Never forget to be a gentleman! If you succeed don't get coranial hypertrophy. It is not the big head that counts, but it's the texture and quality of the brain that makes a strong mind. I have known doctors as puffed up with self-importance that they disgusted their professional colleagues. Such "swell heads" will ultimately be shunned by others. Always be polite, but not effusive. One of our physicians, who has made a pnenomenal success, has always been dignified, courtly and aspiring. He is now at the head of the Indiana Reformatory, and has proven himself to be a man of extraordinary ability. He has climbed steadily up upon the merits of a high character; from being a gentleman under all circumstances, and having devoted his whole soul to an ambition to accomplish great things. He is the impersonation of energy, and with all his honors, he has not been afflicted with "big head."

This is not from Cathell, but from the undersigned.

Jeffersonville, Ind.

URINE IN ITS PATHOLOGICAL RELATIONS TO THE DISEASES OF THE BLOOD.

By S. R. KLEIN, M.D., Ph.D., M.A.

Public Lecturer, Formerly Professor Fordham Uni versity School of Medicine.

In the course of the various enemias, with certain exceptions, the changes that occur in the urine are less marked than might be expected. In simple anemia the urine is pale, feebly acid or faintly alkaline and of low specific gravity, although I found in a few cases 1030, and even higher gravity and-risum teneatis-large amount of red blood corpuscles. Blood examination showed, of course, not more than one million, or at the highest point, one and ahalf million red blood cells.

The daily output of nitrogen is little altered, showing that the proteid metabolism is not materially affected. Hale, White and Hopkins, in a case of enemia, found the ratio PO. : N, almost exactly as in the normal individual. The excretion of uric

acid also is very irregular-sometimes an immense quantity of uric acid is found, that it covers the whole microscopic field; another case shows decrease, a infiinitum.

More certain definitive changes are frequently observed in leucocythæmia, especially as regards the excretion of uric acid, which is usually found to be much increased. In exceptional instances it has been found to reach 3 and even 5 grams in 24 hours. Stejskal and Erben state that the uric acid excretion is less in lymphatic than in splenic leucocythæmia, whilst the contrary holds good for the xanthin bases.

Leucocytosis produces the most changeable conditions, we know that. Especially we find exceptional conditions and consequences in cases where the differential blood count shows large percentage of cosinophiles. Retention of N and Cl. are mostly then observed and in less degree of PO, along with loss of CaO, in spleno medullary leucocythæmia the N balance was maintained Bartoletti found a diminished amount of iron in the urine of leucocythæmic patients.

In pernicious anemia the urine is dark colored; it is usually clear, acid in reaction, and its specifiv gravity ranges between 1012 and 1020; it often has a strong urinous odor, to which attention is sometimes directed by the patient himself. The absorption of food has been found very defective and in consequence of it the urine shows abnormal amount of nitrogen.

Stejskal and Erben found that 17% of the nitrogen introduced in the food, 13.5% of the fat, 6% of the not easily absorbable carbohydrates and 30% of the chlorides were evacuated by the feces; still, at the end of the 4th day a slight positive Nbalance (1.15 grains) remained. The urea nitrogen represented about 85% of the total urinary nitrogen; the uric acid excretion was relatively rather high, 0.44 to 0.76

gram.

In chlorosis the alterations in the urine are but slight. The urine is usually light in color and low in specific gravity, the quantity being above the average. The amount of urea is unaltered, that of uric acid also remains constant, or it may be slightly diminished.

2321 Cambrelling Ave.,

Bronx, N. Y. City.

DUAL ACTION OF TURPENTINE IN A CASE OF TYPHOID FEVER.

THE BRODNAX ACID IRON TONIC.

Turpentine has long been recognized as one of the remedial agents in typhoid fever. Dr. Daniel Leathers told the writer of an unexpected result in the instance of one of his patients at a boarding school, that had been given spirits of turpentine. To a child, aged seven, in the third week of typhoid fever, he gave two drops of spirits of turpentine each four hours, and at the end of forty-eight hours the chid passed a tapeworm nine feet long. Turpentine has for many years been known as an anthelmintic, but in the case of this patient it was not known that there existed a tapeworm, and the remedy was given for other pur

poses.

Dr. Leathers says that his general line of treatment in typhoid fever is as follows. For internal medication the following prescription:

R Bichloride of mercury..... gr. ss.
Alcohol

Acetate of potash..

Essence of pepsin.

gtts, xxx.

.gr. xxx. q.s. ad živ.

M. Sig.-One teaspoonful in water every four hours.

A quart of normal salt solution is given each day by enema for the purpose of keeping the bowels in a free condition, and if there is diarrhea it is used less often. When the temperature is high the sponging of the body frequently during the day is done. During the latter stages of the disease ten drops of spirits of turpentine is given every four hours in the form on an emulsion. Dr. Leathers says that during a period of twenty years he has seen but one case of intestinal hemorrhage and suggests lactate of calcium as a good agent. The diet consists principally of peptonized milk at the onset and as the disease advances a more liberal diet, especially so during convalescence.Ind. Med. Jour.

A recently issued bulletin of the Department of Agriculture recommends a wholesome meat and vegetable soup which will furnish enough for a family of five, at a cost of approximately 16 cents. This may be made according to the following recipe:

Ingredients-One soup bone, weighing about 24 ounces (one-third meat).

Approximate Cost-(Price actually paid by Department chemist) 10 cents.

After being washed it should be placed in a large kettle with three pints of cold water and heated for three hours, when the bone and meat should be removed.

One-quarter of a small head of cabbage, one onion, one carrot, one large potato, two small tomatoes, a little flour, seasoning-6 cents.

Chop these vegetables and add to the soup. Boil the mixture for one hour, thicken slightly with a little flour and season with salt and pepper.

The home-made soup made according to the above recipe contains in addition to meat extractives, gelatin from the bone, some of the food elements in the vegetables, and a large proportion of the fat and meat of the bone.

AMORPHOUS PHOSPHORUS IN SENILE

ARTERIOSCLEROSIS.

Dr. I. L. Nascher, in N.Y. Med. Jour., says: The author has used the red amorphorous phosphorus in senile arteriosclerosis for several years. Given originally as a substitute for ordinary phosphoros in senile de bility, it was found that it was eliminated as amorphous phosphate of lime and that the lime elimination was thereby increased. Weil's experiments showed that the lime. elimination in arteriosclerosis was diminished. Phosphorus has the property of combining with lime and increasing the lime assimilation. In the small doses which can be given when the ordinary phosphorus is employed, the phosphorus will combine with the lime of the food and increase the amount of lime salts in the body. When given as amorphous phosphorus the dose is two grains or more several times a day, and with a lime-free diet the lime required for the combination necessary to secure the elimination of the phosphorus excess, is drawn from the abnormal lime deposits. This appears to be the rationale of the treatment and explains the good results obtained from its use.

PERSISTENT HICCOUGH.

Dr. Francis H. Mead, in the Medical Record, writes: Persistent hiccough is often a troublesome condition, and as many remedies are advised for its relief, the following experience may be of interest:

Major X., on November 23, was suddenly taken ill in the evening. When I saw him that night he had taken a severe chill and was running a temperature of 106.6°. He had previously suffered from a light attack of cerebral apoplexy, and had an enlarged prostate with old interstitial nephritis, and a much dilated stomach. With appropriate emunctory remedies, as the symptoms were due to intestinal autoxication, the temperature became normal the next afternoon, and he expressed himself as feeling much better. On the afternoon of November 27 a slight hiccough developed, for which he was in the first place given some peppermint water, with, as the symptoms increased, a sinapism. He was taking only a liquid diet, and there was no question of gastric distention with

improper food, as this had been fully relieved. He passed a restless night with much hiccough. This persisting during the day, the next night he received 1/50 of a grain of atropine with morphine hydrochlorate, gr. 1/8 by hypodermic injection. He slept better and ther was absence of hiccough for two or three hours, but it was renewed the next morning. I was afraid to wash out his stomach, as he was unused to it, and the previous attack of apoplexy made one careful uot to let him undergo any great exertion. He was given chloretone gr. iij with urotropin gr. xx every two hours, as the urine was alkaline. This had no result. Ringer's mustard treatment was tried, but also was of no avail. I then gave him ten drops of a saturated solution of menthol in spiritus vini rect., in a little hot water. This was to be repeated every hour if necessary. With the first dose relief was experienced, and after four doses in the first twenty-four hours there has been no recurrence of the hiccough. Dilatation with carbonic acid and the posture treatment I did not try, as my patient's condition negatived them.

SODIUM CITRATE IN DYSPEPSIA.

Plicque in Bulletin Médicale for May 31, 1913, states that sodium citrate appears to exert, in the treatment of dyspepsia, several beneficial actions. In the first place, it facilitates the digestion of milk when a milk diet is being given, preventing the formation of large, compact clots where the fluid is drunk too quickly or in excessive amounts at one time. Variot showed that many cases of infantile dyspepsia, such as occur so often in bottle-fed infants, yield when a tablespoonful of the following solution is added to each four ounce (120 gram) bottle of milk: