CHART I.

Child, aged five months; early symptoms both intestinal and nervous, severe. Rapid improvement followed stopping milk, free catharsis and irrigation. After stools had been normal for three days, relapse occurred, apparently from adding milk to the diet, although less than two ounces a day were given.

Autopsy: Intestine showed the usual change of intoxication. Other organs essentially normal.

Two cases similar to Holt's I have seen where an exceedingly small amount of milk was added to the diets of infants convalescing from enteric fever, with fatal results. The milk in these cases, as probably in Holt's, was not a toxic milk, but it revivified the virulence. of the intestinal bacteria.

As a third argument, I present the temperature curves from two consecutive cases of typhoid fever treated last month.

CHART II.

M. McQ., aged 10; severe typhoid infection. Marked nervous symptoms, and scorbutic condition of mouth. Temperature high. Diet, milk. Seen on the twenty-third day of the disease. Milk was withdrawn, and other nourishing liquids given. Temperature lower; pulse improved; nervous symptoms less severe, and scorbutic symptoms quickly disappeared. Good convalescence.

CHART III.

Lucy, aged 11; sick one week. Severe abdominal symptoms simulating appendicitis. High temperature, 104° to 106°. Rebelled against sponging, etc. Admitted to hospital on seventh day of illness. Diet had been milk. On tenth day milk withdrawn. Temperature on two subsequent occasions only rose to 104°. Quickly responded to anti pyretic measures. Pulse and general condition improved. Normal convalescence.

The charts show that these two patients improved as to their temperature, pulse and general condition when milk was withdrawn from their foods. It was not expected that the change in diet would abort the typhoid, but by this means we hoped to lessen the intestinal putrefaction, with consequent bowel irritation and toxic absorption. The patients had the typhoid infection, and it was our aim not to add to it by giving them a putrid, or easily putrescible, substance.

How will we feed our typhoid patients, for we must feed them, and the successful treatment depends in a large measure upon the attention that is given to the diet?

The keynote of the dietetic management is "individualization." Water should be given freely, plain or charged.

Gruels, well cooked and seasoned, strained and malted, if preferred, made from oatmeal, rice, barley, arrow root, or other cereals, have a moderate nutritive value.

Meat broths, or soups, of beef, mutton or chicken have a slight nutritive but more stimulant value.

Meat juice, made by the cold method, contains from seven to nine per cent of proteid, and is a good food, and from five to fifteen ounces may be given a day.

White of egg added to water, gruels or soup enriches them. The yolk of the egg is very rich in fat, and, beaten in with cereals, it makes a very palatable, nutritious food.

Jellies, calf's foot or fruit, are a delicate addition. Fruit juices, of orange, grape, berries, lemon or pineapple are tonic beverages that break the monotony of the sameness of a typhoid diet.

Cream and milk, but the best only, that is certified, may be given very cautiously with other foods; given plain, or flavored with malt, coffee, chocolate, etc., acidulated, peptonized, pancreatinized.

Kumyss, buttermilk, junket, are nutritious milk foods.

This list is merely suggestive, and may be as varied as the needs of the individual require.

The concentrated foods are rarely required, though somatose, tropon, plasmon, plasmon coca, or condensed milk are at times of service.

Do not over feed. Watch the abdomen for gaseous distention of the bowels, and the stools for evidence of indigestion or food putrefaction. If present, correct the diet, rather than administer antiseptic or antifermentative remedies.

Alcohol may be used according to the particular indications in the specific case.

To recapitulate: "Milk alone" is objectionable as a typhoid diet.

1. Because it is intolerable as a sole food to the adult in health or disease.

Because it contains a large amount of poisonous filth.

3. Because in digestive tract infections it feeds the parasitic intestinal flora, rather than the host.

4. Because the systemic intoxication from milk poisoning is so serious and often fatal.

5. Because we have abundant other substances that are without these objectionable features, and are more palatable, equally abundant, as economic, very nutritious, easily digested, and readily assimilated.

103 STATE STREET.

MIGRAINE IN MASQUERADE.

BY ARCHIBALD CHURCH, M. D., CHICAGO.

In the majority of instances the physician is not called upon to make a diagnosis of migraine or sick headache. It is clearly recognized by its victim. But migraine, like the majority of neuroses, is capable of putting on the particolored dress of the harlequin and of disguising itself either by the addition of unusual features or by limitation to a partial programme.

The ordinary attack of sick headache, very often called "bilious sick headache," consists in a series of well marked manifestations occurring with regularity and repeating itself with precision at intervals more or less exact. Commonly there is a phase of premonitory symptoms of heaviness or dullness, which the patient learns to recognize as a forerunner of the more pronounced features. Sensory disturbances then usually develop. These may be confined to the special senses and may consist of disturbance of sight, smell, taste or hearing, those of sight being perhaps the most common. In due course headache appears. At first usually dull, it tends to become severe, but not lancinating and has a decided predilection to one sidedness. With a given patient it is generally the right side, or the left side that is affected, though in some instances a headache beginning on one side transfers to the opposite side before the end of the attack. The headache is usually attended by nausea, sometimes by vomiting, almost invariably by anorexia. After persisting for a period of hours it commonly terminates in a sleep from which the patient arouses completely recovered and with a fine appetite.

The tendency of sick headaches to appear periodically is one of their most pronounced characteristics. With women these periods are prone to fall into harmony with the menstrual rhythm. In men not uncommonly the headache has a tendency to recur every Sunday, owing to the change in habit and occupation that marks the seventh day of the week.

Another feature of migraine that is of the first importance is its association with other nervous disorders and the neurotic heredity commonly presented. In women particularly one obtains a history of migraine in the mother and in the grandmother. It seems to have a tendency to descend by the female side. But a neuropathic family history of wider dimensions is perhaps more commonly encountered. Thus we find migraine in different generations alternating with P. & S. plexus, September, 1902.

hysteria, epilepsy, insanity, periodical drunkenness and with all the grave neuroses and psychoses. Gout and rheumatism, Bright's disease and diabetes are also hereditarily in frequent association.

While so distinctive in typical cases, so easily diagnosed and commonly so generally recognized, migraine may mimic serious organic disease.

A married man, 43 years of age, a civil engineer, some two years ago suffered an attack of aphasia. This was introduced by numbness which began in the right hand, invaded his arm, then the face and speech at first slightly affected, became entirely babbling in character and incomprehensible. Sometimes the numbness would extend to the right side of the trunk and the right lower extremity. The first attack lasted several hours and the physician who saw the patient opined that a severe cerebral hemorrhage had occurred. These attacks have recurred at intervals of a few weeks ever since. Without occurring regularly they have had a tendency to appear in the middle of the day, and invariably present the same train of symptoms except on four occasions when the left side was involved, though the right side was affected before the end of the attack.

These attacks of temporary aphasia are always attended by headache, during which the pupils are contracted. His wife says "his eyes look glazed," and after the attack the pupils are widely dilated. During the attack the hand affected is somewhat clumsy, although motor power is never seriously involved. In marked attacks the headache, which is severe, terminates in a stuporous sleep. This headache is marked at its inception by peculiar sensory symptoms on the part of the eyes. The patient sees fortification spectra, with blurring of vision, usually more marked towards the right side and more pronounced in the right eye.

During the aphasic attack there is inability to read or to write. Unable to express himself by word of mouth, he has on a number of occasions attempted to communicate by means of the pencil, but finds himself unable to form letters or express himself in writing. In attempting to read at such times he does not recognize the meaning of the letters and sees them badly. Sometimes by looking sidewise he can partly see them, but their meaning is not conveyed to him (word) blindness). He has himself noticed that the field of vision is contracted, particularly on looking towards the right, and at other times concentrically so that he seems to be "looking through a tube," as he expresses it.

Upon further inquiry it is learned that his mother had migraine and was rheumatic; that he himself had ordinary sick headaches from his 10th to his 22nd year, when they tended to subside or became at most insignificant until he was 40, when they returned, and a year later were transformed into the attacks described. The rest of his family and personal history is unimportant.

This instance shows a group of symptoms which first hit upon.