the tongue, but I have met with one instance in which there was hypertrophy of certain of the papillæ all over the papillary aspect of the dorsum, with the production of tuft-like growths and which could not well be classed among the true tumors of the tongue." (Page 28.)

Harrison Allen in his "Anatomy" says: "The circumvallate papillæ divides the tongue into two portions, anterior two-thirds, posterior one-third. The posterior third lies within the pharynx, is rich in glands and is loosely covered by a thin, smooth mucous membrane." "The presence of large numbers of glands in the pharyngeal portion of the tongue would suggest the frequent occurrence of glandular lesions here." "The glands are frequently hypertrophied in persons disposed to tubercular disease and are at times the chief cause of irritative cough so noticeable in the first stage of phthisis." In the cases I saw there was no sign of phthisis. In one the cough

was severe.

THE CAUSE OF TYPHOID FEVER AND ITS NEW SCIENTIFIC TREATMENT.*

BY D. MC SWEGAN, M. D.,

President of the San Diego County Medical Society.

GENTLEMEN: Our standard medical works state that the cause of typhoid fever is an infection, arising from sewer emanations and putrifying animal matter, and that it may be conveyed to the human body by water, milk, or infected air. Sewer-air, or large sewers do not cause typhoid fever, but a common hiding place of this cause is to be found in the small, obstructed and badly ventilated house-drains. The questions, then, which I will propound this evening are: 1. What is the typhoid infection? and, 2. The infection having gained access to our system, how shall we rid ourselves of it? These are living questions which medical science has been closely studying for the past two or three years, and in the solution of which a thousand hands are now busily at work, with tools so refined, methods of investigation so accurate, and minds so scientifically trained, as to challenge the admiration of the world.

*Read before the San Diego County Medical Society, February 4, ISS7.

The different forms of infectious diseases which constitute the bulk of all cases of sickness are, according to the present standpoint of science, all caused by specific microbes. Before entering more fully on this subject, I consider it proper to give a crude classification of micro-organisms in general.

For our present purpose it will be sufficient to distinguish between fungi, cryptococci, and schizomycetes. The fungi and cryptococci rarely produce disease as compared with the schizomycetes. Under this head we recognize microbes which are continually identifying themselves with particular pathological conditions. They are known as the micrococci, or round form, the bacteria or oval-shaped, and the bacilli or rod-like. The micrococci are also specially designated according to the felation they assume to each other. When found in pairs they are called diplococci; in chains, streptococci; in bunches, stoptylococci; in masses, zoögloa.

Now, it is absolutely proven that we cannot have suppuration without the staphylococcus pyogenus. But we may have the staphylococci present and not have suppuration. In other words, they must be in sufficient numbers under conditions favoring the developement and growth of their species before suppuration can occur. In like manner it has been proven that the existence of most infectious diseases depends upon the presence of a specific microbe. Thus, for instance, in anthrax we have the bacillus anthrasis; in erysipelas, the micrococcus erysipelatsus; in diphtheria, the micrococcus diphtheriticus; in pneumonia, the micrococcus pneumoniæ; in scarlatina, the micrococcus scarlatina; and a number of others, including that universal microbe, which has made the acquaintance of many unmarried men, and some married men, the gonococcus or micrococcus gonorrhea. Now comes one of the latest microbes, claiming the attention of the scientific world, and the one in which we are particularly interested in the discussion of this paper the germ of typhoid fever, known as the typhoid bacillus.

For our knowledge of this microbe we are largely indebted to such eminent pathologists as Koch, Pasteur, Gaffky, Simmond, Klien, and many others, but particularly to Klebs of Prague, and Eberth of Zurich. These bacilli stain freely with methyl-violet, and are described as rods of various lengths, forming filaments up to .05 M. M. long, and .0002 M. M.

thick, and as producing spores. When we come to consider the minuteness of these spores it almost seems to verify the truth of the old couplet

"Our fleas have other fleas to bite 'em

And so on ad infinitum.”

In patients dying from typhoid fever the characteristic bacilli have been found in accordance with the period of the disease from which death resulted in the following localities; (1) in the small intestines, in the crypts of Lieber, later in the interglandular tissue and in Pyers' patches, still later in the submucous cellular tissue and even in the muscular layer: (2) in the mesenteric glands; (3) in the spleen; (4) in the lungs, in the parts affected with hypostatic pneumonia; and (5) in the brain. At a regular meeting of the New York Pathological Society, held last December, Dr. Pradden presented three sets of cultivations of the typhoid bacilli. The first consisted of plate and tube cultivations from the feces of a patient thirty years of age in the third week of the fever; the characteristic growth being best shown on potato, where the bacilli form an almost invisible film. The second were tube cultivations from the spleen of a typhoid fever patient. The third were specimens obtained from Koch's laboratory, and consisted of three tubes containing bacilli. From a diagnostic point of view cultivations of this kind had considerable value.

The pathogenetic function of these bacilli has been abundantly proven by numerous and exact experiments within the past year. Professor Fraenkle, of Germany, made pure cultures of the bacilli obtained from the spleens of four different typhoid fever cases. These cultures he injected into mice, guinea-pigs, rabbits and doves, using from three to five minims of the gelatine culture fluid. Of the sixteen mice, all died and were found to have enlarged spleen and swollen Peyers' patches, whilst the characteristic bacilli were found in the blood. Of the seven guinea-pigs experimented upon, all died in from five to seven days. On post-mortem examination no peritonitis could be detected, but the spleen was found enlarged, the agminated glands throughout the intestines were swollen, one of them being actually ulcerated, and the mesenteric glands were also swollen. The characteristic bacilli were found in the intestinal wall and the spleen, and in some cases

slight capillary hemorrhages were noticed in the bowel. Of these animals five received the virus directly into the duodenum, while in two it was injected subcutaneously. The inoculated doves and rabbits were found to be not susceptible to the disease, the results on them being negative; but in the cases of the guinea-pigs and mice the results were positive. Within the past year there have been made numerous exact experiments, many of which will be brought to light at the coming International Medical Congress, all proving positive results. These experimental tests are convincing, because they furnish direct evidence by making in the primary and verifying experiments all things equal except the presence or abscence of a certain kind of micro-organism. These microorganisms are now obtained unadulterated with other material, that is, in pure cultivations. Gradually we become as well acquainted with their morphological and biological properties as we are with the chemical and physical properties of organic or inorganic bodies.

Now, if the addition of a certain microbe determines the result of one of two otherwise equal experiments invariably and correctly in a certain direction; if the microbe can be obtained again from the one animal, but not from the other; and if, in new experiments, it always brings about the same results, then we can say that the microbe is the cause of the phenomenon.

Now, gentlemen, with all due respect and veneration for the many trained and scientific workers who have given us such a galaxy of facts, furnishing such overwhelming evidence with all the force of fruitless experiment, I will now anticipate the action of the coming International Medical Congress, and proclaim that the typhoid bacillus is the specific germ of typhoid fever.

THE NEW TREATMENT.

Since the nature, pathology and cause of typhoid has gained such a foothold on true science, I believe that the day is not far distant when we will be treating this dread disease with scientific accuracy, and the basis of that accuracy may be expressed in one word-antisepsis. Antisepsis in surgery has produced results in wound treatment undreamed of a few years ago, and has made accessible to the surgeon regions which heretofore were considered clearly beyond his domain. Anti

sepsis has practically rendered extinct those diseases depending on suppuration, such as pyæmia and hospital gangrene; and, while surgeons may differ as to the relative merits of different antiseptics, they all agree as to the underlying principles. When we look upon these grand results which have been accomplished in surgery, what may we not expect from the same source as we become more intimate with the true nature and cause of disease.

The microbian nature of typhoid fever having been demonstrated, the problem to be solved is, to find substances as deleterious as possible to the parasite, and as harmless as possible to the patient. A variety of substances and conditions are capable of exerting a detrimental influence on the life and growth of micro-organisms; amongst these are the presence of certain substances in the nutrient soil, the temperature, and some chemical products, especially those belonging to the aromatic series, and I will here state that nearly all the successful remedies, including antipyretics and antiseptics, or both, that have been used in the treatment of typhoid fever are derived from this series. The presence of certain substances in the nutritive soil is an essential condition for the growth and multiplication of micro-organisms. Thus pathogenic organisms cannot thrive if proteids or allied compounds and certain inorganic salts are absent, nor can they thrive in an acid medium. Here, then, is a strong hint for the use of acid drinks in the treatment of this disease, for as all the discharges of the patient are alkaline, thus furnishing the most favorable fluid for the growth of microbes, the use of acids is therefore curative. They are also useful in preventing both diarrhea and hemorrhage. Either the mineral or the vegetable acids may be used, and they can be administered per orem or per rectum, as the case might require.

I will now call your attention to the treatment of typhoid by the antipyretic method, of which Liebermeister, in his latest work in "Ziemssen's Cyclopedia," just published, says, that since its advent the mortality has been reduced fifty per cent. The same work also contains this paragraph: "It is interesting to note that most of the antipyretics belong chemically to the so-called aromatic group (derivatives of benzol), a group which at the same time yields many of our best antiseptics. Thus carbolic acid, salicylic acid, benzoic acid, kairine, anti