although the slight fever was a contrary indication. In the larynx there was only slight edema, especially of the left aryepiglottic fold, to be seen. The process speedily subsided, but the prognosis was, with due regard to the bilateral acutely developed glandular enlargement, as well as the described hemorrhage, given as doubtful. This example should suffice to demonstrate how manifold the acute inflammatory processes are which may seize upon the larynx. We will return to the case described at the beginning of this article. A clinical diagnosis of fulminating phlegmon of the pharynx and larynx with consecutive septicemia was made, and this diagnosis was confirmed on autopsy. This last also revealed the wide extension of the pus to the cardiac end of the stomach. But what appeared to me to be remarkable in this case was the bacteriologic study, which, as well from an excised piece of tissue as also in the pus obtained on autopsy, was noteworthy. The pus obtained from the excised tissue showed the following: In a coverglass preparation stained with methylene blue, cocci were seen which arranged themselves in diploform with an indication of a capsule, and were indistinctly lanceformed and arrayed in short chains. Gram was positive, and they were very similar to pneumococci. Culture on agar at body temperature showed peculiar bacteria of a similar nature. The cocci refused to grow on bouillon. The histological examination showed a diffuse, sero-purulent infiltration of the tissue. Finally an examination was made of the pus removed on autopsy. Coverglass preparation revealed cocci, which were arranged in diploform, but were rounder, and a portion of them formed long chains, which had only an indistinct capsule, and which also did not so much resemble the pneumococci. These cocci were likewise positive to Gram. A pure culture made on agar showed neither diplo- nor streptococci, manifestly because they were not capable of further growth, owing to an accidental pollution with staphylococcus albus. There were therefore in my patient cocci which bore a striking resemblance to the Fränkel-Weichselbaum pneumo diplococci, but which could not with certainty be regarded as identical. Doubtless the most of the processes belonging hereto may be ascribed to causation by the streptococcus pyogenes, but every similar case invites close bacteriological examination, because with such considerable material before us, we can perhaps derive many conclusions bearing upon prognosis therefrom. The presence of the pneumococcus is a possibility that must always be borne in mind. Lesser bacteria can likewise cause such a process, as for example Onodi found in two of his cases besides the diplostreptococcus lanceolatus also the staphylococcus aureus. It is recognized that the pneumococcus can occasion different inflammatory processes. Netter's statistics show the following proportions of primary localization of diplococcus : On the contrary, peritonitis caused by the diplococcus as observed by Weichselbaum belongs among the rarities, and likewise pharyngo-laryngeal phlegmon is certainly not frequently caused by the pneumococcus. In examination, as Neusser10 mentions, we have besides the direct bacteriological indications the indirect reactions of different bacteriological influences to bear in mind, for example the conduct of the eosinophile cells on infection of the body with pneumococci, or the great lessening of chloride in the urine, which Neusser observed in his case of pneumococci. In closing I should like to impress the words of v. Schrötter, which in substance are to the effect that only bacteriological investigation can clear up the question of inflammatory edema of the larynx. I have to thank my honored chief, Privy - councillor v. Schrötter, for permission to use these materials in publication. 1. Literature. v. Schrötter: Vorlesungen über die Krankheiten des Kehlkopfes. Wien, 1893. 2. Trofimow: Laryngitis submucosa infectiosa. Allgem. Wiener Med. Zeitung, 1901, No. 8 u. 9. 3. Chiari: Wiener klin. Wochenschr. 1897, No. 5. 4. 5. 7. Kuttner: Das Larynxödem und die submucose Laryngitis. Virchow's Gerber: Acute infectiöse Phlegmone, Erysipelas im Larynx. Hey- 6. Onodi: Laryngitis submucosa infectiosa acuta. Sitzungsberichte der Gesellschaft der ungar. Nasen und Kehlkofärzte, 1901, No. 2. Lombard u. Caboche: Phlegmon retropharyngien gangrenéux, etc. Laryngite phlegmoneuse primitive. Bull et mém. de la soc. anat. de Paris, April, 1901. 10. Neusser: Ueber ätiologisch-bacteriologische Diagnostik. Wiener klin. Wochenschr. 1901, No. 14. TYPHOID FEVER AND ITS TREATMENT.* BY G. C. MORRIS, M.D. SAVANNAH, TENN. Definition. A continued, acute, infectious fever, with intestinal lesions, eruptions, etc. Etiology. Typhoid fever owes its origin to a peculiar poison or germ known as the bacillus of Eberth, originating from decomposition of animal matter, wherever there is a suitable soil (as in sewers) sewer gases, feces, cesspools, crowded localities poorly drained, and especially from wells of insufficient depth in our small towns, where drainage is poor. Pathological Anatomy. The lesions of typhoid fever are emimently destructive. The extent of the changes, as a rule, are indicative of the violence of the attack, but sometimes we have few lesions, still there may be grave symptoms. Pathologic changes that actually occur in the gut during the invasion of the disease are these: there is hyperemia, congestion, ulceration, sloughing, contraction and cicatrization. In the first week we have more or less hyperemia and swelling of the mucous membrane of the ileum. By the end of Read before Tennessee State Medical Society, Nashville, 1901. the first week the infiltration and swelling embraces the whole of the intestines, and on or about the seventh day the ulcers reach their maximum; on or about the tenth day we have sloughing of these ulcers, and contraction begins soon after; about the seventeenth day cicatrization and healing of these ulcers occur, the inflammation gradually subsides and Peyer's patches begin to resume their normal appearance. Symptoms. As a rule a prodromic period ushers in a case of typhoid fever. For a week, ten days, or even longer, a lack of the usual vigor and a disposition to tire easily are perceived, temperature rises to 99°F. on first day, with a gradual increase each day until the seventh, when it reaches its maximum, the temperature being 103 to 104°F. or even higher. The characteristic rose-colored spots can be seen at this time scattered over the abdomen and chest, tongue coated with a brown coat and pointed and tremulous, known at this time as the characteristic typhoid tongue; there is tenderness and gurgling in right iliac region, with tympanites, diarrhea, or there may be constipation; during this period the patient gives a history of having had epistaxis, frontal headache and general muscular malaise; enlarged spleen is most always present in these cases. Treatment. When I first see my typhoid patients I clear out the alimentary canal with calomel, combined with carbonate of soda, given in broken doses, and thoroughly cinchonize the patient. Repeat calomel and soda every two or three days during the first week, and follow with quinin each time. The calomel and soda are given dry on the tongue. For flatus and tenderness in the abdomen I give the following prescription R Oil turpentine, 3ij; syrup acacia, 3iij. M. Sig.: take teaspoonful three times a day, and continue it until all pain and tenderness disappear. In addition to this I give salol in two and one-half grain doses three times a day. A few remarks as to why I use salol: Bartholow says, and I take it that he is good authority, salol continues intact during its stay in the stomach, but when it reaches the intestines it is at once dissolved. So, by giving it, do we not apply it almost directly to the parts affected? It is eliminated by the kidneys as salicylic and carbolic acid. It also has an antipyretic effect and aids materially in lowering the temperature. Above all my aim is to keep the fever from running above 103°F. If I find it running above that temperature, I have the patient sponged off with cold or tepid water every two hours, especially in the afternoon of each day. In case this fails to keep the fever down to 103°F. or even below, I use large doses of quinin, repeated every four hours for its antipyretic effect. Stimulants. Give them only when it is necessary. If pulse becomes weak and fever has about subsided or temperature becomes subnormal, give good whiskey freely. And when I find an unusual amount of muscular weakness of the heart's action I give strychnia three times a day for the purpose of toning up the heart's action. Diet. Ice cold sweet milk, or buttermilk if sweetmilk disagrees with the stomach. I also allow the juice of an apple or an orange, and some other liquid diet, as a change; allow them no solid foods whatever. Hygiene. Have the room well ventilated, and all furniture removed except that which is necessary to remain; have each stool removed as soon as passed and thoroughly cleanse the nightglass, and use carbolic acid freely about it and room; and last, but not least, allow no one in the room except those necessary to wait on the patient. I have given the basis of my treatment in one hundred and nineteen cases, treated in succession, without a single death. I would be pleased to hear from any one who has tried these remedies; and if you have not, I think, if you will, you will form the opinion that I have. UNIQUE CASE OF RENAL CALCULI. BY R. J. HEALD, M.D. AURIS, MISS. ON October 7, 1899, I was called to see C. S., suffering from what I took to be nephritic colic. Gave him an opiate, combined with free doses of spirits niter. He rested very well that night. I saw him again on the 8th. He had passed a small stone and was better. Continued niter and laudanum and prescribed a purgative of cathartic pills. On the 12th I saw him again. He was very weak and still suffering. I |