they consider that in the matter of books, as in other things, there is "room at the top." We think that this volume will find a fairly high place in ophthalmic literature through sheer merit. The object of the writers has been to present to the students of ophthalmology" the subject-matter tersely, practically and comprehensively." This they have succeeded in doing in the compass of 500 pages of good, large print, and with a profusion of clear and large illustrations, which are quite the best we have seen in a book of this size. In consequence of the large print and the number of illustrations the reading matter is comparatively small in amount, but ample for the needs of the student and practitioner, for whom we think it is an ideal text-book, being comprehensive without being too exhaustive; lucid without being prosy; and its physics are made clear without the aid of higher mathematics. In the past, students have been in the habit of complaining that eye books are either too big or too small for examination purposes. We think that "Hansell and Sweet" is neither too big nor too small, but just big enough, so it should at once allay that grievance of the student. The value of the book is enhanced by special contributions on “Diseases of the Lachrymal Apparatus, Orbit and Cavities accessory to the Orbit," by Christian R. Holmes, of Cincinnati; "On Ocular Symptoms in General Disease," by Casey A. Wood, of Chicago; and on 'The Pupil in Health and Disease," by Wendell Reber, M.D., of Philadelphia. These sections are written by men who have given special attention to their respective subjects, and consequently are of the nature of authoritative monographs which may be consulted with advantage by ophthalmic surgeons. In fact we have read the whole book with much advantage, and consider it the most lucid, practical, and up-to-date textbook for its size we have had the pleasure of reviewing.

The Therapeutics of Mineral Springs and Climates. By T. BURNEY YEO, M.D., F.R.C.P.; pp. 760. London: Cassell and Company. 1904.

DR. YEO defines a medicinal water as a water which, either from its chemical composition or its thermility, or some other quality which experience has proved it to possess, is found

useful in the treatment of disease." Acting on this definition, he gives descriptions in this book of the waters of a great number of places, many of which have probably never been heard of by the majority of English medical men.

The book opens with some general remarks as to the composition and classification of mineral waters; then comes a chapter on their mode of application and action. A description is given of the waters and climate of all the chief European Spas. This part of the book is particularly valuable, for it gives the kind of information wanted by the patient, e.g., as regards the character of the place, the scenery, &c., and also the information wanted by the medical man, namely, as regards the composition, administration, and action of the waters. There is a useful chapter on climate and climatic resorts in general, and another on English, Scotch, and Irish coast climates.

We commend this book strongly to every medical man, who is at times called upon to give advice on these subjects.

Guy's Hospital Reports. Vol. LVIII.

Edited by J. N. BRYANT, M.D., and F. J. STEWARD, M.S. London: J. and A. Churchill. 1904.

THE most important article in this volume of the Guy's Reports is one by Sir Cooper Perry and Dr. Lauriston Shaw, on the cases of Malignant Disease of the Stomach recorded in the Pathological Records of the Hospital between the years 1826 and 1900. The greater part of the article consists of notes of more than 300 cases, extracted from the registers. Another paper worthy of note is that by Dr. Hale White, on "Disease of the Heart due to over-indulgence in Alcoholic Drinks."

BOOKS RECEIVED.

From Messrs. J. and A. Churchill

Clinical Diagnostic Bacteriology, including Serum Diagnosis and Cyto-diagnosis. By ALFRED COLES, M.D.

From Messrs. John Wright and Co.—

:

Our Baby For Mothers and Nurses. By Mrs. LANGTON
HEWER.

From Messrs. Rebman

Health and Disease in Relation to Marriage and the
Married state. Edited by H. SENATOR and H. KAMINER.
Translated by J. DULBERG.

From the Surgeon-General U.S. Army

Index Catalogue Surgeon-General's Office, U.S. Army.
Second series. Vol. IX.

SOME VARIETIES OF TYPHOID FEVER, WITH A CONSIDERATION OF SOME OF THE CAUSES OF DEATH. *

BY R. M. SIMON, M.D., F.R.C.P., Physician to the General Hospital, Birmingham.

EIGHT years ago I had the honour to read before this Branch a paper on the treatment of typhoid fever, and I propose this afternoon to take for my text the following remarks I then made about variations in the course and causes of the symptoms.

"It is impossible for anyone who has had a large experience of typhoid fever-whether in the course of family practice or in hospital-not to have been struck by the extraordinary difference that may appear during the same epidemic in cases of the disease, so much so that I have often wondered whether we may not sometime have to go still further in the differentiates of the disease which ended with Jenner's distinguishing it from typhus, and find that we have more than one disease to deal with. It may be possible that in typhoid, as in other diseases, we have to deal with complex conditions. We meet with the ordinary form of the disease, in which the evidence of the poison is mainly upon the intestinal tract; and with other cases in which, apparently, the intestinal tract has escaped, and the specific poison has spent itself upon the thermogenetic centre, upon the heart, or upon the lungs. As in other diseases which run a more or less definite course, we come across certain cases which terminate fatally within a period short of that at which we are wont to regard our patients with anxiety, and very short of the time when we may anticipate danger from the occurrence of the hæmorrhage or perforation which may result from the severity of the intestinal lesions. Our patients die almost before the

* A Paper read before the Birmingham and Midland Counties Branch of the
British Medical Association.

disease has developed, and I cannot but wonder if some cases of so-called septicemia may not really be due to the absorption of an enormous dose of typhoid-fever poison, which, by its effect upon the nervous system, causes death before the pathognomonic symptoms of the disease have had time to

assert themselves."

I have quoted this passage, not in any sense as an evidence of prescience, but to show that the ideas therein expressed have been present in my mind during the last eight years, and to have formed the basis of the work which this paper purposes to illustrate. The discovery of paratyphoid fever is an argument in the truth towards the disintegration of the idea of typhoid fever as a single clinical entity.

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Paratyphoid fever is due to the paratyphoid bacillus. The paratyphoid bacilli (for there are two races) are organisms intermediate in their characters between the true typhoid bacillus and the colon-bacillus, and are placed in the socalled "Gartner" group. The name paratyphoid" bacillus appears first to have been used by Archard and Bensaude in 1896, and was re-introduced by Schottmuller in 1901, and would seem to be the preferable designation for those microorganisms that produce typhoidal symptoms. The para

typhoid bacilli, as a rule, resemble the typhoid bacillus in morphology, that is to say, they are multi-flagellate (6-8-12) actively motile bacilli, which do not stain by Gram's method, and do not form spores. Their growths on agar and gelatine also resemble those of the typhoid bacillus, but on other media present striking differences. As regards the agglutination (Widal) reaction, the blood of the paratyphoid-fever patient either does not agglutinate the typhoid bacillus (i.e., Widal reaction is negative "), or agglutinates it only in low dilution, e.g., 1 in 30 or 40; while it agglutinates the paratyphoid bacilli in far higher dilution, e.g., 1 in 100 or 200, or even higher.

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These observations are extracted from a paper by Dr. Hewlett in the Practitioner of January, 1904, and are based upon a collection of about 100 cases. Symptomatically, paratyphoid fever simulates typhoid in every detail, but pathologically it differs somewhat, inasmuch as in none of the fatal

cases have ulcers of the intestines been found, nor has endothelial proliferation in the lymphoid tissue of the intestines, in the mesenteric glands, or in the spleen, been discovered.

It is possible that typhoid and paratyphoid fevers may occur simultaneously in the same individual, and perhaps the case I will now describe was of such a nature. The diagnosis of paratyphoid disease in this case was only made after repeated examinations for typhoid bacillus had proved negative. No doubt had been entertained that the patient was suffering from typhoid, the presumption of the existence of this disease being strengthened by the fact that the patient became ill at the same time as two other women, who had undoubted typhoid, at the same time and in the same ward. All three of these cases showed how greatly the disease typhoid may vary, as one of them proved to be of a severe type, with alarming hæmorrhage occurring from time to time, which seriously endangered the patient's life. The third case was of an exceedingly mild type, but bacteriological proof of its typhoidal origin was present throughout.

M. D., a girl of twenty, was admitted into Ward 13 at the General Hospital on March 24 last year, suffering from pain in the stomach after food, and other symptoms suggestive of ulcer of the stomach ; on more than one occasion she had had hæmatemesis. For a fortnight after admission she did very well, and was getting up, but had to take to bed the third week of her stay in hospital on account of general malaise, associated with a temperature which rose in a manner pathognomonic of typhoid. She had no cough, epistaxis, or hæmorrhage of any kind; no rash, no sordes, but the spleen could be felt below the margin of the ribs; the abdomen was moderately distended, and a persistent diarrhoea was present; the stools were like those of an ordinary case of enteric, but were not foul. She remaind in a febrile condition for about three weeks, at the end of which time the temperature gradually went down, until in the fourth week it became normal. Two Widal tests were negative, but a third examination, made in the seventh week of her stay in hospital, showed paratyphoid reaction in five minutes, and the typhoid and bacillus coli communis reaction in three-quarters of an hour.