usual fluctuations, returned to the normal at the end of four weeks; during this period he went through the regular course of typhoid fever of rather more than usual severity. After he had passed the height of the disease his recovery was delayed by an attack of milk-leg. When this had subsided, and his temperature had become nornal, and had so continued for several days, he had a sudden rise of temperature to 104° one afternoon (November 2d), but there were no other symptoms of disorder, and on the next day the temperature was 100°, and afterward gradually subsided to normai. I find that the temperature rose again on the 20th of November to 105°; subsequently it remained steadily high for nearly a week.

There is a class of cases, of which I have seen a number, in which there is a substained fever-temperature after all other signs of the disease have passed away and the patient is convalescent. In this class of patients I have seen the temperature fall from 100° to normal as soon as they were permitted to get out of bed. The temperature would apparently remain elevated indefinitely, without any other sign of disease, as long as they were kept in bed. This has taught me that in some cases, if you want to get them well, you must get them out of bed; too much coddling does harm. The sustained abnormal temperature makes the physician, nurse and patient afraid, though all the other appearances are favorable. When the patient is allowed to sit up, gradually extending the time, the temperature falls.

There is another class to which I wish to direct your attention. Of course it is understood that elevation of temperature frequently occurs from indiscretion in diet. These instances I need not refer to further. I merely mention them to complete the series. In this man the first elevation I referred to was caused by reading a book, and that in the boy had a similar cause. The boy was of very impressionable nature, and when a schoolmate called upon him and insisted upon seeing him after his attack of typhoid fever, he became very much excited after his friends had gone away, and cried for some time. That evening his temperature went up to 105°. Mental emotion, then, may be a cause of high temperature during convalescence from typhoid fever.

This does not, however, completely cover the case before you. I took the patient out of bed, forbade any excitement or mental effort, but the temperature continued high, although he had no diarrhea or other symptom of disease. Examining the case repeatedly, I could find nothing but constipation that was amiss. Upon looking carefully for a cause

why the temperature remained elevated, it occurred to me that it might
be due to constipation, the fever-temperature being caused by irritation of
hard masses of retained fecal matter in the intestine. I ordered this man
a daily enema and one drop of fluid extract of belladonna three times a
day. This I had found in previous cases effective in correcting a tend-
ency to constipation after typhoid, where irritating purgatives would be
dangerous. Now here the effect was very soon apparent.
I have to re-
port that the temperature fell to normal as soon as the intestines were
freely evacuated, and has remained so.
He now has a daily movement
his temperature is 98.5°. He is

of bowels, feels well, though still weak;
no longer confined to his bed.-Louisville Med. News.

MYXEDEMA AND CRETINISM.-The pathology and relationships of myxedema seem to be gradually coming into clearer light. The cases of Professor Kocher, of Berne, had a distinct value in pointing to solid facts which might assist in a comprehension of the etiology of myxedema. Professor Kocher had himself performed 101 total or partial extirpations of goitre, and requested those patients operated upon some long time before to present themselves for re-examination. Of these, 34 were seen. In 16 of these cases, a partial extirpation only had been made; that is, one lobe, with or without its isthmus, had been removed. In all these cases, the results had been very satisfactory; the dyspnea had disappeared, and the general health had suffered in no respect. The remainder of the 34 patients, namely, 18, had undergone complete extirpation of the thyroid; of these, two only showed an undeteriorated state of health; in one of these two cases, a small accessory thyroid gland had beeome hypertrophied, whilst in the other a recurrence of the goitre had taken place. All the remaining 16 patients showed derangements of the general health, which were distinctly of a progressive character, as they were worst in the patients operated upon the longest time beforehand. These changes were all in the direction of myxedema, and were subsequently identified as such by readers of Kocher's paper. As Dr. Simon remarked, "not one symptom was present in myxedema which was not met with in these cases of total extirpation." It was further observed, however, that in those cases in which the patients at the time of operation had been still young and growing, all development was arrested directly afterwards; they thenceforth ceased to grow. This symptom is not present in myxedema, which is a disease that has hitherto been found only in adult life. Thus, as the speaker observed, there appeared to be three conditions closely allied to

each other, and having in common either absence, or probably complete degeneration, of the thyroid body; namely, cretinism, myxedema, and the state after total removal of the thyroid body. In all three states, certain conditions of arrested development of mind and body were met with, which could hardly be attributed to anything else but to the loss of the thyroid body, common to them all. He added, as a speculation, that, if the absence of the thyroid gland would lead to arrested development of mind and body, it might also lead to the arrested development of the higher forms of organized tissue, and permit simply the formation of the lowest type of tissue, the fetal tissue, that mucin which, in myxedema, exists in such excessive quantities. At the meeting of the Clinical Society, on the 24th ultimo, when Dr. J. Anderson gave an account of a case of myxedema, Dr. Semon again drew attention to this subject, and cited a remarkable case—that of an individual who had a goitre eighteen years ago, when he was ten years old, and whose thyroid gland was at that time entirely removed by Dr. Sick, of Stuttgart, with the result that his growth was immediately arrested, and he, who had formerly been a bright and lively child, had since become a dwarfy cretin, with all the symptoms, bodily and mental, of myxedema superadded. The conclusion to which the case seems to point is, that "the loss of function of the thyroid gland would appear to produce both cretinism and myxedema.”Brit. Med. Jour.

SOME THERAPEUTICAL DELUSIONS.-THE New York Medical Record, after carefully examining some "delusions" sent it by a correspondent, and finding that in the main they agree, with results of the more conservative clinicians and of pharmacological experiment, publishes them as follows:

"It is a delusion that veratrum viride or aconite will abort croupous pneumonia or essentially modify its course; that potas. chlorate is of any use in catarrhal angina; that potassium nitrate is an antipyretic, antirheumatic, or (to any appreciable extent) diuretic; that lime-water will, in practice, dissolve diphtheritic or croupous membrane; that nitrate of silver is of any value in epilepsy; that the excessive and continued use of iron produces plethora with dizziness, flushings, and palpitations; that iron should be given in phthisis; that mercury is antiplastic and antiphlo gistic; that arsenic has any value in diabetes mellitus; that potassium iodide promotes absorption of serous exudations and non-specific connective tissue in hyperplasiæ; that sulphur and sulphur in baths is of any

value in rheumatism; that charcoal, when moist in the stomach and intestines, has any absorptive power, or is of any use in flatulence by virtue of that power; that dilute acids are 'cooling,' i. e., lower temperature and lessen heart-action in the non-febrile; that colchicum is of benefit in rheumatism; that drinking sulphuric acid prevents chronic lead-poisoning; that iodoform given internally is anything but a poor substitute for potassium iodide; that croton-chloral has a specific effect on the fifth cranial nerve; that tannic acid (or the plants containing it) is of any value internally for hemorrhages, except perhaps those of the stomach and bowels, or that it is of any value as a gargle in chronic pharyngitis, or that it is an astringent to mucous surfaces and blood vessels; that turpentine is a stimulant to the heart and nervous system; that musk is a nerve or heart stimulant (it belongs, with turpentine, to nerve depressants); that ox-gall is of the slightest therapeutive utility at either end of the digestive tract; that hydrocyanic acid in ordinary medicinal doses is either a local or general sedative (it is rather an irritant); that quinine in either small or large doses is a stomach tonic, except in convalescence from malarial attacks; that hydriodic acid has any specific effects other than those possessed by the iodides."

DIABETES.-Dr. Austin Flint, jr., adds four more cases of diabetes to the fifty-four reported to the American Medical Association. The patients were placed on strict anti-diabetic diet, and Clemen's solution of arsenite of bromine, beginning with three drops, increased to five, was also given. Of these four cases three were permanently relieved. conclusion he adds, "Diabetes has become to-day a disease easily and certainly curable, provided that the treatment be not begun too late."

The following is his diet-table:

In

BREAKFAST-Oysters stewed, without milk or flour; clams stewed, without milk or flour. Beefsteak, beefsteak with fried onions, broiled chicken, mutton or lamb chops; kidneys, broiled, stewed, or deviled; tripe, pig's feet, game, ham, bacon, deviled turkey or chicken, sausage, corned-beef hash without potato, minced beef, turkey, chicken, or game, with poached eggs.

All kinds of fish, fish-roe, fish-balls, without potato.

Eggs cooked in any way except with flour or sugar, scrambled eggs with chipped smoked beef, pickled salt cod-fish with eggs; omelets, plain or with hams with smoked beef, kidneys, asparagus points, fine herbs, parsley, truffles, or mushrooms.

Radishes, cucumbers, water-cresses, butter, pot-cheese.

Tea or coffee, with a little cream and no sugar. (Glycerine may be used instead of sugar if desired.)

Light red wine for those who are in the habit of taking wine for breakfast.

LUNCH OR TEA-Oysters or clams cooked in any way except with flour and milk, chicken, lobster, or any kind of salad except potato, fish of all kinds, chops, steaks, ham, tongue, eggs, crabs, or any kind of meat, head-cheese.

Red wine, dry sherry, or Bass' ale.

DINNER-Raw oysters, raw clams.

Soups-Consomme of beef, of veal, of chicken, or of turtle, consomme with asparagus-points, consomme with okra, ox-tail, turtle, terrapin, oyster or clam, without flour or milk; chowder, without milk or potatoes; mock turtle, mullagatawny, tomato, gumbo filet.

Fish, etc.-All kinds of fish, lobsters, oysters, clams, terrapin, shrimps, craw-fish, hard-shell crabs, soft-shell crabs. (No sauces containing flour or milk.)

Relishes-Pickles, radishes, celery, sardines, anchovies, olives.

Meats-All kinds of meat cooked in any way except with flour, all kinds of poultry without dressings containg bread or flour, calf's head, kidneys, sweet-breads, lamb-fries, ham, tongue, all kinds of game, veal, fowl, sweat-breads, etc., with currie, but not thickened with flour. (No liver.)

Vegetables-Truffles, lettuce, romaine, chicory, endive, cucumbers, spinnach, sorrel, beet-tops, cauliflower, cabbage, Brussels-sprouts, dandelions, tomatoes, radishes, oyster-plant, celery, onions, string-beans, watercresses, asparagus, artichauts, Jerusalem artichokes, parsley, mushrooms, all kinds of herbs.

Substitutes for Sweets-Peaches preserved in brandy without sugar, wine-jelly without sugar, gelee au kirsch without sugar, omelette au rhum without sugar, omelette a la vanille without sugar, gelee au rhum without sugar, gelee au cafe without sugar.

Miscellaneous-Butter, cheese of all kinds, eggs cooked in all ways except with flour or sugar, sauces without sugar, milk or flour.

Almonds, hazel-nuts, walnuts, cocoanuts.

Tea or coffee, with a little cream and without sugar. (Glycerine may be used instead of sugar if desired.)

Moderately palatable ice creams and wine-jellies may be made, sweetened with pure glycerine; but although these may be quite satisfactory for a time, they soon become distasteful.