ment had been resorted to. The last was a dilation of the cervical canal, and the insertion of a glass stem. As she was not benefited by any treatment, she was sent to the writer for an abdominal section, April 4, 1904.

The ovaries were found very tense and cystic.

The coverings of the ovaries were removed, the utero-ovarian ligaments shortened, and the abdominal incision closed. The patient has had her monthly periods regularly since the operation, and with but very little discomfort. Her general health has greatly improved.

Some time in the years to come the physician, after having diagnosed a case as typhoid will produce from his satchel a syringe, which he will load with a serum, and, as the relatives stand open-mouthed around the bed, he will inject the serum into the patient, who will immediately start upon the road to recovery.

Of course this is a prophecy, but it is based upon substantial grounds, because the serum treatment of typhoid can already be dimly discerned through the fog of the future. Until the time arrives when we can treat typhoid as we now treat diphtheria, hydrophobia, or tetanus, we shall probably be compelled to continue as we do at present; that is, to put the patient to bed, and wait until he gets well, endeavoring in the meanwhile to avoid doing anything that will make him worse, and changing his environment so that it will correspond with what, in the light of our knowledge, we regard as the most favorable condition for recovery. We now put the patient to bed to save his muscular strength. We give him cold baths to reduce the fever, and if he is noisy we give him opium to keep him quiet. We also feed him generously in spite of his protests, because we know that patients often look after recovery as if they had been starved, and while we admit that we know nothing about the processes of assimilation or nutrition in typhoid, still it is the custom to feed them, and so we feed them, being careful not to give them anything that is solid or tough when it leaves our hands; whatever consistency it assumes after the patient has swallowed it makes no difference, our responsibility ending when we have delivered it to him.

Read before the Aberdeen District Medical Society, of South Dakota, November 22, 1904.

One of the soundest principles in medicine is to secure rest for an inflamed part if we wish to have it recover. have it recover. This principle, applied to typhoid, would mean that we should secure rest for the intestine; and rest for the intestine means absence of peristaltic movement and non-distention of the bowel by gas. Of course both of these conditions are present in typhoid, but if we add to them, instead of reducing them, we are not benefiting our patient, sufficient bowel movement for drainage being all that we desire.

For the purpose of this paper I shall leave out the phenomena of typhoid other than those relating to the intestines, and proceed at once to question the value of milk as a food, and to inquire into its alleged highly nutritive properties.

Milk, through custom and because it is diametrically opposite to alcohol, has acquired a sort of sanctity, which is supposed to allow it to pass without question when it is suggested for any purpose connected with the sick-room. Is it not nature's pabulum? Is it not highly nutritious? Is it not a liquid food? Does it not fulfill all of the indications, and supply every nutritive element necessary?

Let us examine more closely some of the unsupported claims for milk as a food, implied in an affirmative answer to these questions.

It is a scientific fact that the milk of the mother at the time of the birth of the offspring differs entirely in chemical composition and nutritive qualities from her milk at the time that the offspring is ready to be weaned, or until the advent of the teeth. A consideration of this fact alone cannot fail to convince us that nature does not intend milk to be food for the adult. The failure of milk to meet all the requirements of a food for the developing young is a fact very well understood by specialists in children's diseases.

The second claim, that it is highly nutritious, has been contradicted by the classical experiments of Ewald. This careful observer had a number of people placed in cells, and fed them on nothing but milk. After ten days' confinement these people emerged in a most wretched state of emaciation, the loss of weight being something remarkable. Ewald concluded from this that the adult stomach is not large enough to hold sufficient milk to keep up the nutrition of the adult individual; in fact, he concluded that the nutritive properties of milk as a food for the adult are greatly overestimated, being in reality insignificant. He concluded, moreover, that milk is not a liquid food, being only liquid until it reaches the stomach, where it is promptly changed, especially in febrile conditions, into a tough peristalsis-provoking substance, which makes an excellent medium for microbes, and will produce much gas when conditions are favorable; in other words, it is capable of fulfilling all of the indications that we don't want fulfilled in typhoid, namely, increased peristalsis and increased distention of the intestine with gas, yielding only a small amount, if any at all, of nourishment as a compensation.

Most of the medical journal writers on the subject of typhoid suggest some system of stuffing, claiming that the patients, when they recover from the stuffing which the writers advocate, look less emaciated, have more resistance, etc. But these gentlemen must surely have the usual mortality of typhoid, and if so they must also have patients who have barely escaped with their lives. It stands to reason, then, that they must have patients in every degree of emaciation, and that their judgment must be colored slightly by their desire to see good results follow the particular method of stuffing of which they are the votaries. An explanation of the process of normal nutrition is one of the hardest questions that science has been called upon to answer. If this is so, what can we say of assimilation and the nutrition of tissue under abnormal conditions? In fact, it is a question whether nutrition of tissue can take place at all in the presence of the microbes and ptomaines of disease like typhoid. This question belongs in the domain of physiological chemistry, a young but expanding science.

We have now arrived at the point where we ask ourselves what, then, shall we feed our typhoids if milk and other cherished foods are found to be disappointing? On reading the text-books we find that almost every edible that ever existed has been offered to the typhoid without arousing him from his indifference to, and often disgust for, food. Might it not be worth while to take a hint from nature when she removes the appetite from our patient? Is it not possible that we magnify the importance of feeding when we pour what we call nourishment down the throats of our semiconscious patients, often exposing them to the dangers of inhalation pneumonias, etc.? May it not be that the benefit derived from alleged liquid nutriments, such as milk, is due more to the watery component than to the theoretical nutritive element? The watery part of the foods may compensate in some degree for the water loss in the patient, this water loss having a good deal to do with the emaciation. However, this water loss would appear to be more rationally compensated for by drinking of an abundance of water. If we could be sure that we were not reinforcing the enemy in the battle going on between the natural resources of the patient and the disease, we should have. decided on a suitable diet for typhoids long ago. Do not the conditions in typhoid resemble closely enough the conditions in acute appendicitis, so that some modification of the treatment recommended by Ochsner for, appendicitis would be appropriate for typhoid, especially when the disease is at its height? Not exactly to starve the patient, but only to give him food when he had. an appetite for it. The physician often places more value than it is worth on the text-book logic which says that a patient who is going to be sick a long time with a wasting disease should have. a large amount of food put into the alimentary canal to keep up his strength.

The practitioner should never follow the hospital practice of giving every typhoid patient a glass of milk every four hours, nor should he endeavor to apply any rigorous rule whereby every typhoid is given the same kind of food at stated intervals, because, as in other diseases so in this, every case is a law unto itself. If milk is given because it is relished by the patient or be

cause it is the most easily procurable article, it should not be given under the impression that the patient is receiving either a highly nutritious or a liquid food.

Alcohol rubbing is highly to be recommended in private practice, and is doubtless of nutritive value, absorption taking place through the skin instead of through the stomach. An abundance

of water should be drunk to make up for the water loss and for its antifebrile effects.

To sum up: We are obliged to confess that as we do not understand the processes of nutrition in diseases like typhoid, we shall have to be content to trust to the natural resources of the patient to accomplish his recovery until such time as science is able to lead us out of the darkness.

"Doctor, I got syphilis five years ago and have suffered more or less from it since. The old aches and pains became unusually severe about eight weeks ago. I then got constipated. I had cork-screw pains in my stomach and bowels, poor appetite, headache night and day, and gradually developing weakness. I have been rubbing 'anguintum' into my skin on my own responsibility, but I am getting worse, and I want you to fix me up."

"Auto-intoxication and, perhaps, too much mercury," said I to myself, wisely. "I'll unload his bowels, then I shall start him on a course of antisyphilitic treatment."

"Take the medicine this prescription calls for, strictly according to directions. Take no other medicine, and return to me in three days."

Three days later the man dragged himself into my office, whispering, "I am worse than ever, Doctor."

I eyed the patient awhile, saying to myself, "Here is an urgent case of syphilis; I had better record it."

HISTORY.-Male, single, aged 44, born in Ireland. Acclimated. House-carpenter. Non-alcoholic. When well, bowels regular. Drinks tea and coffee moderately. Smokes and chews moderately. Sleeps well. Bathes seldom. Hygienic surroundings bad. Had worked out of doors for three months preceding present illness. FAMILY HISTORY.-Excellent.

HISTORY OF PREVIOUS DISEASES.-Smallpox in youth. Five years ago, syphilis. One year la

Read before the Crow River Valley Medical Society at Minneapolis, December 14, 1904.

ter, a fever and liver complaint. Gonorrhea five times during the past ten years; the last attack, one year ago. Perfect recovery. No injuries.

HISTORY OF THE PRESENT DISEASE.-Eight weeks ago, after sleeping two nights in a close, freshly painted room, he began to have a "coppery taste." Lost appetite. Bowels got obstinately constipated. Deep, boring, frontal, constant headache. All kinds of pains in the epigastrium and bowels, soon extending over all the body. The abdominal pains mostly colicky, referred to navel and epigastrium. In a few days muscles of forearm got "trembly and thin; then they got numb and almost useless." Body and legs also got weak and emaciated. Couldn't lift hands. Then came a few days of mild delirium, succeeded by impaired memory. Food sometimes relieves pain in stomach. Some nausea and vomiting before and after meals, from the first day of illness. Stream of urine tardy and twisted. No stricture. Is very weak. Thinks pains now less urgent. The medicine prescribed produced mild catharsis.

OBJECTIVE SYMPTOMS.-Medium size. Bald. On back, legs extended. Body and limbs emaciated. Face pinched, anxious. Skin of face and body sallow-gray and moist. Eyes dull; sclerotica muddy; pupils respond to light. Temperature 98.8°. Pulse 120. Respiration 7, steady. Tremors of arms, aggravated by movement. Extensors of forearms totally paralyzed. Breath fetid. Tongue pasty. Pharynx normal. Teeth filthy. Gums red and bleeding. No blue line. Deglutition normal. Thorax negative. Abdomen flat. Gradual pressure of hand on episgastrium and

cision was made at the seat of pain. No pus appeared, and the pain continued and was so intense that it was only by the use of morphine that he could rest at all. The whole hand now became swollen. The swelling extended to the arm, and on the 24th he was brought to the hospital and the hand freely opened, but only a little serum escaped.

The patient appeared anxious and was evidently suffering intensely. His temperature was then 102.8°, and it continued to rise until the antistreptococcus serum was injected with the result as shown in chart No. 1. Two other injections 'were made, one of 60 c. c., the other of 30 c.c. and the effect was always immediate.

The temperature has gradually descended to normal following the usual septic curve, and on Dec. 21st, he was discharged from the hospital, although he is still under my care.

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