Heredity may lead to differentiation of stone. It is seldom that repetitions of hepatic colic do not occur.

Operations for removal should not be performed unless the typical symptoms are present. Cases occur more frequently than is supposed giving rise to symptoms elsewhere.

There is no medical treatment efficient for the disintegration or removal of gall-stone. The indication is to relieve pain, and for this the best agent is by far hyoscyamine.

DISCUSSION.

Dr. Hugh M. Taylor quoted Robson, who lays stress on the characteristic suddenness of the paroxysmal pain. Vomiting may be continuous or paroxysmal. In some instances pain is referred to the left shoulder; often, above the umbilicus, differing from that of appendicitis. Subsequent attacks may be from the same stone. The direction of growth of the tumor is diagnostic, being obliquely toward the umbilicus. It may be enormous, sometimes, then, being mistaken for ovarian tumor. Distension of the gall bladder without jaundice, means obstruction of the cystic duct, as by enlarged gland stricture of stone. Sometimes a diagnosis may be made by the presence of Hemorrhage, when present, is due to poisoning incident to cholœmia. In this latter we have continuous jaundice, which means neoplasm of the duct, or head of the pancreas. Stone, by its change of position, etc., will allow the escape of some bile, jaundice accompanying it being thus intermittent.

stone in the fæces.

The question of peritonitis is important. A stone near the papilla is a foreign body, and as such it irritates and leads to the establishment of peritonitis, which may become purulent. Chills, fever, sweats, etc., occur here. Inflammation may result in perforation of the gall tract, setting up peritonitis thus. From malaria differentiation is sometimes impossible. Dr. Taylor said he could recall cases in his own practice in which diagnose was only made by the autopsy.

Solvents are myths, and the only medical indication is to relieve pain.

Dr. J. S. Wellford reported two cases of cholelithiasis. Most cases, said he, of gout commence with violent pain, especially in the right hypocondriac region, and this should be borne in mind in diagnosing gall-stone and appendicitis.

WINTER COUGH.-Lippia mexicana is almost a specific in the hoarse, barking winter cough without secretion, so common in northern climates.—N. Y. Medical Times.

Selected Papers.

THE TREATMENT OF TYPHOID FEVER BY GUAIACOL.

BY A. P. HULL, M.D., Montgomery, Pa.

That typhoid fever is so universal that it usually attacks persons in the prime of life, endowed with the powers of resistance against disease, and yet with a mortality too high to be satisfactory, is the excuse I have to offer for reading a paper before the Society on a subject so threadbare as this. The symptoms require no description; the question of burning interest to us is, What can we do to reduce the mortality?

During the months of September, October, November and December, 1894, and January and February, 1895, I had under treatment 32 cases of typhoid fever, and in a majority of these cases used a plan of treatment that was so entirely satisfactory that the results seem to justify reporting. These cases were not confined to any one locality, but scattered through a village and over a valley of considerable extent. While we have sporadic cases of typhoid fever every year in this valley, about every decade, especially after a very dry season, we have an endemic like this, until the disease has become a curse and dread to the people of this community.

If typhoid fever can be almost blotted out by having an uncontaminated supply of drinking-water, as is claimed in some European cities, then the water in the rural districts must contain the bacillus typhosus, although examinations very often give negative results.

Of

The first 11 cases were treated medicinally with nitrate of silver and quinine, given continuously from the beginning to the end of the disease. these II cases 2 died.

Having 2 cases just beginning in the family of Mr. T., whose son had died, I decided to treat them with guaiacol internally and externally.

These 2 cases, with all the others following-19 in number-were treated with guaiacol internally and externally, and an occasional grain dose of calomel, three or four times a day, until slight purgation took place, when it was stopped, but resumed again, unless the patient had three or four loose passages every twenty-four hours. Along with this the bowels were frequently washed out with large douches of warm, soapy water, or, if the fever was high, cool water, which was always agreeable and gave comfort to the patient. The guaiacol was given in from 1 to 1-drop doses every two hours, according to the tolerance of the patient for the drug night and day. The temperature was controlled by the external application of guaiacol and cold sponging. The external application of guaiacol will lower the temperature in about thirty minutes, and is preferable to the cold bath, as it is

equally efficacious and can be applied where the latter is not practicable. The effects will last from three to four hours, but the amount should be small at first (from 5 to 10 drops), and gradually increased, as it is liable to give the patient a chill. The largest dose used at any one time was 20 drops. As in the case of any other drug, one person may require more than another, but patients become susceptible to its influence and the effects are greater with each application.

Outside of the chills, which occurred with the larger applications, I cbserved no deleterious effects from its use. The chills can be avoided by a careful application of the drug, the temperature not being reduced below 100° F. The drug was applied over the abdomen, which was first washed with soap and water and dried. The guaiacol was then slowly dropped on the parts, carefully rubbed in, and covered with oiled silk.

The shortest duration of any one of these cases was fourteen days, the longest twenty-four, and the average between nineteen and twenty days.

I have always been well satisfied heretofore to see typhoid patients get rid of the fever in twenty-eight days, and many of them, even uncomplicated cases, still later; therefore the early convalescence in these cases-the gain of a week--was not due to accident.

The diet was the usual liquid diet-meat broths and milk, the latter generally diluted. Stimulants were used when indicated, but were not required to any great extent. The highest temperature reached was 105.4° F., and most of these patients, at some time during the disease, reached a temperature of 104° F., thus showing the fever to have been of some severity.

Convalescence was most rapid in the cases where treatment was most promptly applied.

Now, I realize that this number of cases is not large enough to demonstrate anything positive or to draw any absolute conclusion in regard to the treatment of typhoid fever, as you might have this same number of cases and give them very little, if any, medicine, and they would all get well; yet these patients, during an endemic that was sufficiently virulent, all recovered so much better and earlier than any same number treated before, being practically well a week after the fever had left them, that it was evidence to my mind that the guaiacol had some value in modifying and cutting short the disease.

Many of the symptoms that the 11 cases before had, and that we usually have, were slight, or, perhaps, entirely absent. Tympanites and delirium were rare. The tongue was generally moist, and the diarrhoea did not.

assume that uncontrollable character so often found.

That typhoid fever is caused by a specific germ-the bacillus typhosusis now admitted, though their presence is sometimes hard to prove. The activity and life of this bacillus end at the latter part of the second week from the initial symptoms of the disease; but about this time the necrotic

and sloughing process of the mucous membrane and Peyer's glands takes place, leaving what is equivalent to an open wound in the intestinal tract.

From this time on the symptoms are kept up by putrefactive bacteria, especially the bacillus coli communis, which becomes virulent during the latter stages of the disease.

We cannot put each one of the open wounds in an aseptic condition, as a surgeon would do, but we can, I think, make the intestinal tract less habitable for micro-organisms, and the clinical history of these cases seems to me to prove the anti-fermentative action of guaiacol and other antiseptics in the intestines.

The phenol group undoubtedly occupy the first rank as germ destroyers and germ poison neutralizers outside of the body, and during absorption, as they are never found free in the blood, and combine with albuminous substances, especially with the most reactive of these, the toxic albumins, the products of microbic life, forming compounds, probably non-toxic. They undergo rapid oxidation in the system, and can be found in the urine. They, therefore, would not only destroy the disease germ in the intestinal tract, but would effect a rapid elimination of the toxic albumins from the system. From my observations in these cases the following conclusions seem justified:

1. That the antiseptic treatment of typhoid fever is a rational treatment. 2. That guaiacol is a safe remedy in typhoid fever, and prevents the toxin poisoning of the later stages due to the bacillus coli communis and other putrefactive germs in the intestine.

3. That guaiacol will lower the temperature in typhoid fever, when applied externally, and, with ordinary care, can be used with safety.

4. That typhoid patients do better by keeping the bowels acting up to a certain point, rather than checking them, and will derive comfort and benefit from daily douching of the large intestine with warm or cool water.-Therapeutic Gazette.

MORPHINE HYPODERMATICALLY. It is necessary, after giving a hypodermatic injection of morphine, to maintain perfect silence in the room where the patient is lying. Morphine, far from suppressing sensitiveness, like chloroform, rather tends to exalt the excitability, and particularly the liabil ity to disturbance from slight noises. The failure of morphine injections to produce sleep is, in the majority of instances, due to neglect of this simple precaution.-Lyon Medicale.

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Editorial.