cellular development; and healthy tissue is not only not endangered by its influence but is greatly stimulated thereby. Radium is a dangerous element; while iridium is a reliable medicine. I present this subject, realizing I am practically alone, as no predecessor has attempted to write on the medicinal powers of iridium, and while my experiments have been limited to the efforts of one man, they have not been in vain,

Post-Typhoid Sepsis.-Prof. Delafield (Medical Record) presented a paper on this topic at the recent meeting of the Association of American Physicians. He gives a number of temperature charts to illustrate his points. He speaks briefly of true relapses-that is, after a period of time without fever, the patient has a true relapse. a second complete attack of typhoid. Other post typhoid fevers he places in two groups: 1 Those where there is a slight rise of temperature at certain times of the day, or for a few days, without other symptoms. These are unimportant and no attention need be paid to them. 2 Post-typhoid fevers that are of real importance; last for one or more weeks but do not make the patient very ill and are not fatal. Delafield states he has repeatedly seen this type of fever running from two to four weeks. The morning temperature is normal, or nearly so, the evening temperature ranges from 100 to 103; it may make jumps to 106 or 107. There may be chills with very high temperature. There is no delirium or sleeplessness. The tongue is clean and moist. The patient is hungry; a liquid diet is indicated. 3 Severe and long-continued post-typhoid fevers that appear to be of septic origin. These may be fatal. Delafield says baths do not control the temperature as in true typhoid. The best thing to do with the bad cases is to take them out of bed and feed them. He acknowledges it requires courage to do this; but he thinks it the only thing that will save the patient's life. He cites a number of interesting cases to prove his point. In closing Dr. Delafield says: "The impression I have received from the study of such cases is that at the end of a typhoid fever there may come in a new infection which resembles a streptococcus infection. This infection may be mild or severe. With care I think it can usually be distinguished from the typhoid infection. The point of practical importance is that this infection calls for different management from that of typhoid fever. The best results are obtained if the patients are fed and taken out of bed." These secondary fevers occur in private practice as well as in hospital practice.

CONDUCTED BY

WILLIAM TOD HELMUTH, M.D.,

GEORGE W. ROBERTS, PH.B., M.D.

GALL STONES AND DISEASES OF THE BILE DUCTS.*

THER

BY H. F. BIGGAR, M.D., LL.D.

Cleveland, Ohio.

HERE is no class of systemic diseases that more fully and richly repays the student than that chosen for this occasion. There is none that calls into keener exercise the knowledge of physiology, physiological chemistry, the laws of blood and nerve supply, all in the abnormal as well as normal aspects, than this. Nor is there one, in either its medical or surgical views of successful treatment, that demands more rigid exactness of differentiation of mechanisms involved, or the means to be employed to secure satisfactory results, than the gall-bladder and ducts.

There is scant opportunity for a treatise on the subject, therefore I do not undertake it, but shall only give consideration to salient features, those lying in the way of the busy practitioner rather than in that of the specialist. And setting for myself a limit, let it be that of affections of the gall bladder and its ducts, and of these again, cholecystitis and cholangitis, inflammation of the cyst in one case and of the ducts in the other, and of a chief result, cholelithiasis.

It will also be observed that I do not confine such consideration to either medicine or surgery as such; for the one might forever find limitation falling short of cure, and the other deal only with a last fixed stage, a hopeless incident. It is not that I discourage medication-our best hope may lie there-nor deery operative measures in those cases demanding the knife; but I do plead for thorough and intelligent treatment of the same cases in their early stages with either medicines or the knife, or both in full view and easy reach.

With a warning that the surgeon's knife may be too frequently used, an eminent surgeon says: "The domains of medicine and of surgery can never be separated. It may fail to gratify the physician to see surgery obtain quickly and by a few strokes of the knife what medicine had failed to accomplish; but, on the other hand, has not the physician to stay, and with advantage, the hand of the surgeon? The immunity with which the most formidable operations are now performed has given a confidence-might I not say a recklessness—

* Read before the American Institute of Homeopathy.

possibly which renders the staying hand of the physician of priceless value. Especially is this true when, as it sometimes happens, the inexperienced surgeon hurriedly resorts to a tentative operation to establish a diagnosis, where one more experienced would see no reason for the procedure. I have more than once observed the meddlesomeness of a surgeon to be in a direct ratio to the measure of his inexperience."

It is their duty to become intimately acquainted with causes and clinical history and physio-chemical variations in these diseases, and their differential and specific tissue changes, that insure the position of vantage.

There are some facts in the surgical history of cholelithiasis, or gall-stones, that are suggestive. The era of gall-bladder surgery began in 1879, when there were in England one hundred and seventy-two deaths. In 1889, after ten years' experience, there were four hundred and eighty-eight fatal cases. Kehr, of Halderstadt, who has performed more operations for gall-stones than any other operator, gives a series which shows that a certain per cent. demand re-operation, either from the "first operation not being complete or to a return of the disease." It is a well-known fact that after operations for the removal of biliary calculi other stones are frequently passed, and even after the removal of the gall-bladder stones have been found in the bile ducts. In adults one out of ten have gall-stones, of the old one out of every four; and four times as many women are affected as men. Only one out of every thirty requires the knife.

It is concluded, therefore, that while in the simplest cases the mortality may be as low as one to three per cent., it is in complicated cases as high as five to thirty per cent. In the experience of Mayo Robson, a published series shows sixteen and six-tenths per cent. of recoveries.

In view of such a record, many of the cases being, without doubt, not in the class of last resort, we may carefully heed a remark of Treves, that "the operation for gall-stones is an excessive zeal on the part of some of our colleagues." At all events, we are impelled to return to a more searching review of the conditions the premonitions of which are gall-stone formation, and thus on to the radical cure of the diseases of which they are the expression, by medication.

What is a gall-stone? A crystalline, friable mass, composed of cholesterin, lime, iron, and various bile salts and resins, precipitated and caught up and bound together in a matrix of albuminous material.