The next day, Tuesday, the pains in his arms had ceased, but the calf and heel of right leg were paining him considerably, though the rhythm had ceased and the pain was more of a dull throb. Complained of pain in both ears. Temperature 102°F.; pulse 110. Bowels had moved freely during the night, several times. Was able to eat oatmeal and toast for breakfast, the first nourishment except milk which he had taken since Sunday dinner. I saw him this day about 9 A.M.

At 7 P.M. of this day (Tuesday) I was again telephoned for and found the pains in legs and arms again as severe as on my first visit, and a foul muco-purulent discharge from each ear. Gave another hypodermic of morphin, atropin and strychnin, and left a prescription for a boric acid wash for ears, to be given with a small syringe. Temperature 103°F.; pulse 115 and weak. I then left, intending to bring an ear specialist if he was no better in the morning.

When I returned the next morning (Wednesday) I found, to my surprise, the ears had ceased discharging, pains gone, normal temperature and pulse, and the patient, whom I had considered in rather a critical condition the night before, able to sit up in bed. Said he felt very well, but weak.

Next day he came to my office complaining of a slight frontal headache; no pain anywhere else; had no fever; had slept well the night before. He has been perfectly well ever since. He asked me several times what I thought was the matter with him. I told him I didn't know.

I neglected to say I obtained a sample of the discharge from his ears, which under the microscope showed pus-producing germs in numbers.

Case II. Last September I operated upon a young woman for the cure of dysmenorrhea. The anesthetist gave ether at the close of the operation. When the etherizer removed the cone we found the right side of the face wet and cold from the ether which had constantly dropped on her face through a hole in the side of the cone. The time the cone was over the face was about half an hour. The leaking cone was partly my fault, in not looking more closely at what the etherizer was doing, and partly his, in using a cone which was defective. The cone used was an ordinary straw gauntlet, lined inside and out with cheesecloth and packed in the bottom with cotton fastened in. We put her to bed with a hot cloth. covered with vaselin next to the right cheek. She recovered successfully from the operation for dysmenorrhea, and said she felt no pain in her face, which however was a little hard to the touch.

Five days after the operation she had a sudden attack of pain in the right side of her face, which in a few hours developed the usual symptoms of Bell's palsy. Speech and deglutition were interfered with, and the face was drawn toward the sound side, especially when she tried to speak. There was practically no pain. This condition persisted for three weeks and finally ceased, and today she is as well as ever.

The only treatment was the application of hot cloths twice a day to the affected side, and faradic electricity three times a week.

This was apparently a case of traumatic Bell's palsy, and I wish to call your attention to the fact that ether, when carelessly given, as in this case, coming in contact with the skin for too long a time, is capable of causing it.

It is said that levity is occasionally enjoyed by doctors as well as laymen, so I will relate the following incident:

Case III. An old maid of, say 35, to be generous, came into my office one afternoon about two weeks ago, to be examined for life insurance. You all know the usual questions necessary to ask before you examine the applicant's heart, lungs, etc. I wish to say first that the lady had never been examined for insurance, and of course the questions were new to her. I got her to answer the various questions with reluctance on her part until we came to the question, had she ever had any diseases of the lungs? Here she said, "Young man, what is the use of asking me all these foolish questions? Can't you see I am in good health? Just write across that paper I am all right, give me my policy and let me go, as I have some shopping to do." I explained as gently as I could that it was not in my power to hand her a policy; that this was sent from the home office if she was considered a good risk by the medical director, and the company required these questions to be answered by the applicant. She snorted, again expressed herself of the belief that it was nonsense, as she knew she was all right, but she would go on to answer. After an enormous effort on my part, I finally got her to answer every question, examined her heart, lungs, pulse, chest measurement, etc., much to her evident disgust, and in the midst of a constant stream of expostulations. Then we came to the last— the examination of the urine. I felt when I broached the subject to her there would be trouble, and I was not disappointed. I explained that everything was now finished except the urine examination, and if that was as good as the rest she would, I feel sure, have no difficulty in obtaining her "policy."

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Her face flushed and her eyes grew angry as she asked what I meant. I said, "According to the rules of the company every applicant's urine must be examined." Young man, said she, "do you mean to tell me you expect me to give you some of my water in a bottle, to look at?" "Yes, madam," said I. Said she, "I never heard of such a thing! I consider you a very vulgar and indecent young man, and shall have nothing more to do with you or your company." With these chaste remarks she flounced out of the office, and I sighed and sat down. I have not seen her since.

Odd Fellows Building.

FEEDING IN FEVERS.*

BY D. M. HALL, M.D.

MEMPHIS.

IN reporting the following cases I hope to be able to convince you of three facts concerning the dietetics of continued fevers, whether typhoid or malarial:

1. That it is not always necessary to limit the patient to a liquid diet till the end of the fever.

2. That such a limitation may be one of the chief factors in the prolongation of the fever.

3. That solid food given before the subsidence of the fever in a great many cases not only does no harm, but may be one of the chief factors in reducing the fever and shortening the length of its duration.

W. Gilman Thompson, in the last edition of his work on Practical Medicine, says: "I have seen genuine scurvy produced by the too long continued use of an exclusive milk diet, which certainly protracts convalescence; and while relapses are common enough in this disease, just as many occur among patients who may be still upon an exclusive milk diet as among those fed earlier. Typhoid fever is essentially a relapsing disease; about 10 per cent. of all patients have a relapse, no matter what their treatment may be, and many relapses are due rather to intestinal auto-infection, or streptococcus infection, than to any reopening of ulcerated surfaces in the intestine by solid food or the delusive febris carnis; no more solid food can enter the bowel at any time than undigested * Read before Memphis and Shelby County Medical Society, Nov. 18, 1902.

milk curds, and as Henry has written, it is not so much solid as indigestible food that should be eschewed.'"

Case I. Mrs. L., aged 40, white, widow. This patient had several chills at irregular intervals, followed by a continued fever. Whether or not her fever was intermittent in the beginning I do not know. I saw her first on the eighth day of her disease. The fever was then remittent in character, and was running from 993°F. in morning to 101°F. in evening. Patient had been taking small doses of quinin during the first week of her illness. She was complaining of nausea, headache and aching in her bones. Epistaxis had occurred on one or two occasions, but was not severe. Her bowels were constipated, spleen moderately enlarged and indurated, and hepatic dullness normal. I gave her ten grains of calomel in one dose, and five grains of quinin sulphate every four hours for twelve doses. The purgative acted well, but the only effect of the quinin was to slightly reduce the temperature. The fever gradually rose after the quinin was discontinued, and ranged from 101°F. in the morning to 103-4°F. in the afternoon. The stools numbered four or five per day, and were watery and offensive. The case was then diagnosed as typhoid fever. The patient was put upon a strictly liquid diet, and betanaphthol, five grains every six hours, was prescribed. This treatment was continued for four or five days without producing any perceptible change in the condition of the patient. She still complained of attacks of nausea, but retained all medicine and nourishment. Temperature 101-104°F. I then prescribed acetanilid, grains five, to be given whenever the fever reached 103 °F., and to repeat the dose in two hours if necessary. Exclusive liquid diet was still continued. Two weeks later the temperature was running to 103°F. in afternoons, and patient had two or three rigors, followed by a rise of fever. Sulphate of quinin was then given in the same manner and quantity as previously. The fever subsided to 99-101°F. All med icines were then stopped and the patient put upon stimulants in addition to liquid diet. I would like to say here, that in all these cases the nourishment consisted principally of milk, and was administered every two hours while the patient was awake. Ten days later the temperature was from 100 to 102°, pulse rapid and feeble, bowels constipated, and patient very weak. I then told her that, not knowing what else to do, I was going to try an experiment upon her by giving her anything she wanted to eat. That my treatment so far had been of little or no benefit to her, and that if she was determined to die, she might as well do so with a full stomach. She ate

for dinner sauer-kraut, pickles, cornbread and beer. For supper she had ice cream, coffee and cake. Next day her highest temperature was 102°F. She continued to eat anything she pleased, and at the end of a week the fever disappeared and she was discharged as cured.

Case II. P. Murphy, male, white, aged 17. This was a case of continued fever diagnosed as typhoid-malarial. I did not see the patient until the eighth week of the disease. Prévious to that time the disease had run the usual course. Dr. Henning had charge of the case when I saw it. Dr. Henning was unable to see the case that day, and requested me to make the call. I found the patient feeling very well, with no pain in the abdomen, and bowels in fairly good condition. He had been upon a liquid diet since the beginning of his disease. His temperature was averaging 991°F. in the morning, and 102°F. in the afternoon. He complained of being very hungry. I ordered for him a small beef-steak, coffee and one biscuit. That night Dr. Henning asked me how the patient was doing. I told him he was doing very well and that I had ordered beef-steak, coffee and biscuit for his supper. Dr. Henning did not approve of the diet, and remarked that we would very probably have a death in a day or so. Next day he called to see the patient and was astonished to see him bright and cheerful and his temperature lower than on the previous day. The solid food was continued, fever steadily declined, and in a few days the patient was discharged as cured.

Case III. Boy, white, aged 14. Occurred two weeks after Case II. Diagnosed as a case of continued malarial fever. The usual symptoms were present. The patient was put to bed and quinin sulphate and calomel in full doses were administered. The temperature was lowered very little. He was then put upon capsules containing quinin bisulph. gr. ii, acid arsen. gr., calomel gr., acetanilid gr. iii, one capsule four times. This treatment was continued for two weeks. The temperature was lowered by the antipyretic, but rose again as soon as the capsules were stopped. The patient had been upon liquid diet from the beginning of the disease. All medicines were now stopped, and at the end of a week the fever was ranging from 100 to 102°F. This was the twentyeighth day of the disease. The patient was then put upon solid food, beginning with rare tenderloin steak, tea and toast. At the end of ten days more the temperature was normal and the patient was discharged.

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