there was much diarrhea, and believed that as a result the disease ran a milder course and was less protracted. The administration of calomel in this way has been widely practised both in this country and on the continent, and as the result of my own experience of it I am convinced that in suitable cases its effect is exceedingly beneficial.

It is not every case, however, that will derive benefit from the treatment. The fact, I think, is not sufficiently recognized that in exceptional instances a dose of three or four grains of calomel, even when given not later than the end of the first week, will directly induce an intestinal irritation, as evidenced by diarrhea and colic, which tends to persist and may seriously prejudice the ultimate course of the attack. The diarrhea, as, perhaps, is not unnatural, is then apt to be wrongly regarded as a symptom of the fever rather than an effect of the calomel. I have been so impressed with the reality of this risk in several instances that I have given up the routine use of calomel in the early stages of typhoid fever, and now restrict its administration to cases in which there exists some special indication for its employment. It is interesting to note that Sir Thomas Watson, though quite unconscious of their antiseptic properties, was very favorably impressed by the action of the mercurial salts in typhoid fever. He stated that he was constantly struck by the fact that when a soreness of the mouth was observed in his patients they showed marked signs of an improvement, and but rarely died from the disease. It is during the early stage of the attack up to about the middle of the second week that the salts of mercury have usually been employed, and in respect to calomel, its use, except in very small doses, should be practically restricted to this period, since to give it in purgative doses after the establishment of ulceration is rarely admissible.

Of the numerous drugs of the antiseptic class which have. been recommended by different physicians for administration at frequent intervals throughout the whole course of the disease, their names are legion. In addition to the perchloride and biniodide of mercury may be mentioned sulphate of quinine, chlorine, sulphurous acid, carbolic acid, boric acid, salicylic acid, and the salicylates of bismuth, sodium and quinine, beta-naphthol, salol, thymol, eucalyptol, turpentine, terebene, camphor, chloroform water and many others. During the course of the last fifteen years I have tried most of these remedies, and in the majority of instances have been disappointed with their action. Several of them I have tried very thoroughly, reverting to their use again and again in consequence of the remarkably favorable

results which have been recorded at one time or another as having attended their employment. I refer more particularly to carbolic acid, salol, and turpentine. As the net result of my experience with these various agents in actual practice, I believe that some of them, when given in frequently repeated doses, are capable of exercising a distinctly favorable influence on the course of the attack, even when their administration is not commenced until after the end of the first week. I do not, however, believe they are competent either to cut short the attack or to lessen to any appreciable degree the risk of hemorrhage, perforation, or relapse, as has been contended by the most ardent advocates of the antiseptic method.

Drugs of the antiseptic class vary very much in their value, some of them apparently being next to useless, and the same drug is not necessarily the most suitable in every case. I am of opinion, after a considerable experience of its use, that the administration of sulphurous acid in from 20 to 30 minim doses every two or three hours is capable of checking fermentative changes in the bowel, with the result that in most cases the tendency to diarrhea and meteorism is lessened, the tongue remaining moist and the stools being rendered less offensive. A good plan is to give the sulphurous acid in an ounce of chloroform water with the addition of 15 minims of syrup of lemons. Administered in this way the taste is not unpleasant and patients take it readily.

I am inclined to regard the oil of turpentine as a remedy of somewhat greater value. It should be given in frequent doses from as early a date as possible. Its value as an intestinal antiseptic and as a diffusible stimulant is highly spoken of by Sir John W. Moore, who is also impressed with its power of relieving respiratory complications; and in that opinion I am disposed to concur. The presence of marked albuminuria or of vesical catarrh, however, should preclude its employment. In the latter case ten grains of urotropine may with advantage be given three times daily, even though the urine be free from typhoid bacilli, but its influence in cystitis associated with the bacillus coli is very slight. I have seen more than one instance in which the continued use of turpentine appeared to be responsible for the development of definite nephritis in a person whose urine previously contained but a slight amount of albumin.

To one of these agents, in my opinion, a somewhat higher value must be ascribed, and that is the combination of quinine and nascent chlorine. In its administration I have followed the

formula advocated by Dr. Burney Yeo, i.e., 40 minims of strong hydrochloric acid are poured on to 30 grains of powdered chlorate of potassium in a 12-ounce bottle, which is filled up gradually with water, the mixture being frequently shaken as the water is being added so as to absorb the gas as it is evolved. To the solution when made 24 grains of sulphate of quinine are added, and of this an ounce is given every two or three hours until convalescence is reached. Care should be taken that an interval elapses between the administration of the medicine and the next feed of milk, which otherwise is liable to undergo some clotting in the stomach as a result of the admixture. Under this treatment the tendency to intestinal fermentation certainly appears to be lessened, and the strength of the circulation is usually well sustained, with corresponding benefit to the general aspect of the case. In some instances, it must be confessed, the result is disappointing, but in cases which come early under treatment, the course of the disease is usually favorable.

During the last two years I have treated a series of cases with the essential oil of cinnamon. This agent was suggested to me by Dr. J. Carne Ross, of Withington, near Manchester, who had been much impressed with the exceptionally favorable course pursued by several attacks of enteric fever which he had treated with it. It was in view of his anxiety that its value should be tested on a more extensive scale that I was induced to give the cinnamon a trial. The results, as far as they go, have certainly been favorable, but the number of cases in which I have tried the drug is not yet sufficiently large to warrant a conclusion of very general application. Up to Sept. 30th last the number of cases treated with the cinnamon has been 147, not counting a few patients in whom its use had to be discontinued after a few doses, in consequence of its having induced vomiting. Of these 147 cases 14 died, representing a mortality of 9.5 per cent.

It is far from my intention to urge the claims of any therapeutic agent merely because the death-rate in a particular series of 147 attacks happens to come out somewhat lower than the average under other methods of treatment. The drug would have to be tested in a far larger number of cases before any trustworthy inference as to its value could be drawn from a consideration of the death-rate alone. As an illustration of the fallacy of generalizing from insufficient data, I may mention that of the first 50 cases treated with oil of cinnamon only two died, whereas, amongst the next 50 no less than eight proved fatal. After careful observation of the progress of the individual cases comprising the series I can only express my firm conviction that the in

fluence it exerted in the large majority of attacks was a good one, and that a certain proportion of the patients who recovered would not have done so had the cinnamon been withheld and the treatment been conducted on purely expectant lines.

The favorable effects which were noted as attending the administration of the drug were:

1. The temperature in the majority of cases ran at a lower level than is customary in enteric fever, the mean of the daily records taken every four hours approximating 101 degrees instead of 102 degrees or more during the full development of the fever. This effect was a good deal more pronounced in cases brought under the treatment at a comparatively early stage of the disease.

2. The patients remained for the most part drowsy throughout their illness, many of them evincing a constant tendency to sleep, as a result of which mental rest was secured and delirium was less frequent. Here, again, the good effect of early treatment was apparent.

3. Intra-intestinal decomposition, as evidenced by abdominal pain, distension, and fetor of the stools, was controlled to an extent which was really very striking. A considerable amount of success in this direction can usually be obtained with various other antiseptic agents when administered in adequate and sufficiently frequent doses, but that the oil of cinnamon is especially efficient as an intestinal antiseptic is evidenced by the fact that, with the exception of several patients in whom the condition was present at the time of their admission to the hospital, no single instance of meteorism cccurred among the 147 cases which were treated with it.

The soporific influence which cinnamon in full doses is seen to exert in so many patients is a factor of undoubted value in the progress of the attack. Despite the nausea, and even vomiting, which cinnamon occasionally induces when given in too large a dose at the outset, the remedy soon established itself in the favor of the nurses, who often remarked on the drowsy, restful condition of mind which resulted from its continued administration-a condition of mind so eminently desirable in a person suffering from enteric fever. To obtain the full effect of the cinnamon a dose of from two and a half to five minims of the essential oil should be given every two hours from the time the case first comes under treatment until the temperature has fallen to the normal. I am in the habit of continuing its administration every four hours during the first week of convalescence and then three times a day for a week longer. The patient, there

fore, is kept to some extent under the influence of cinnamon, for a period of a fortnight after the febrile stage has passed. It is well, however, to give the drug in smaller doses to begin with so as to accustom the patient gradually to its very pungent taste. By commencing with a dose of two and a half minims and increasing it to four or five minims, in the course of a few days the likelihood of vomiting being induced by the cinnamon is materially diminished. Care should be taken that the quality of the drug is above reproach. The better quality of oil is distilled from the cinnamon bark. It tends to become darker on keeping and its odor is by no means unpleasant. Cinnamon oil of an inferior quality is distilled from the leaves of the tree. It is usually lighter in color than that prepared from the bark and it is very much less expensive. This inferior oil should never be used medicinally, as patients do not take it so well and its action is probably less efficient.

The nausea and consequent repugnance to the taste of cinnamon which some patients evince may usually be overcome by using some discrimination in respect to the dosage at the commencement, coupled with the exercise of a little tact and persuasion on the part of the nurse. Should, however, the pungent flavor of the drug still continue to be a source of complaint, the difficulty can be obviated by giving the oil in gelatin capsules. Some patients, however, do not swallow these cachets very readily, and prefer to take it made up in the ordinary way as an emulsion. With a dose of from three to five minims, administered every two hours, the system soon becomes fairly saturated with the cinnamon. Its characteristic odor is very noticeable in the breath, in the exhalation from the skin, and is readily detectible in the stools in most cases. In the urine, however, the odor of cinnamon can rarely, if ever, be detected.

Being desirous of estimating the antiseptic influence which cinnamon oil is capable of exerting on the growth of the typhoid bacillus, one of my colleagues, Dr. A. F. Cameron, kindly undertook an investigation into the question. Working with a 1 per cent. emulsion of cinnamon oil in distilled water containing the minimum necessary amount of mucilage and a twenty-four hours' broth culture of the bacillus, which agglutinated readily with at I in 200 dilution of typhoid serum, the procedure adopted by Dr. Cameron was as follows: A number of tubes containing five cubic centimetres of neutral peptone broth, after the addition of varying amounts of the cinnamon emulsion, were inoculated with a loopful of the culture and incubated at 37 degrees C. These were examined both as regards the appearance of the broth and