the gland ducts. The tongue is dry in fevers—as pneumonic, exanthematous, or typhoid-where they promise fatally. It is also in diabetes, because of the renal drain of the body fluids. There is a bare, red tongue, most often dry, shrunken and cracked, met with in septicemia -common in the puerperal type-chronic empyema, liver abscess, and in advanced phthisis. This tongue is characterized hectic (Butlin). The organ becomes hardened— board-like; sores may form on it, which will crack and cause bleeding. Should a humidity at the edges supervene, it will show that the absorption of toxic matter is restrained and that the vital forces are overcoming in the fight. Another dry tongue, lessened in size and nearly bare, where the papillae are shed like hair of the head, is not uncommon to the prematurely old or to those who are wasted in health. A somewhat similar state obtains in a disease of the organ known as xerostomia.

Fissures in the tongue often have no clinical significance; the patient may not remember when they were not present. Butler thinks they are sometimes the result of chronic liver trouble, chronic dysentery or diabetes mellitus.

"Fur on the tongue," says Butlin, "whether in health or disease, is composed partly of epithelial scales and of debris of food, but especially of micro-organisms." These organisms are always found entangled in the layers of the epithelial cells on the hair-like processes of the papillae, seldom in the depressions between. They are not found on the fungiform, and rarely on the circumvallate papillae. It is shown that when the coating is thin and scraped off, large numbers of the papillae are removed; but when the coat is thick and spontaneously thrown off, micro-organisms are chiefly shown. DaCosta holds that the loosened cell-scale covering of the papillae, when

sticky, wraps around the hair-like processes and in being scraped off, in the act of mastication, elongate the processes and so give the furred appearance to the tongue, implying that this glutinous property of the epithelium is because of faulty function of the glands, which, in turn, is because of a deranged state of the system. It is easily shown that debris of food engages in the filiform processes and adds to the furry coat. It is well to say here that the character of the food or drink may alter the color of the fur, misleading the attendant to believe it due to a suspected disease. The tongue, lightly furred in health, easily becomes heavily coated in many disorders of the system-especially of the digestive system. In acute general diseases, as is their severity and the effect of their ravages upon the vital combative forces of the body, so is this coat darker, heavier and dry. In an acute sickness-as pneumonia or typhoid-usually, the tongue, moist, light or yellowish at first, becomes, as the illness progresses, dark-brownish, more heavily coated and dry, as the gland activity of the body is lessened; thus evidencing a depraved state of the system and the exhausting effect of the disease. It is not a good prognostic sign. But a brighter prospect may show. The margin of the tongue may now become moistened slightly, the tip clear; gradually down the center comes a break in the coating; the mucous glands beginning work again, moisten and loosen the covering; it is thrown off and the tongue appears fresh and clean, to indicate a returning general gland activity. The dry tongue without coating may follow to point to a reinvasion-in the lung if it be a pneumonia, or more involvment of the intestinal wall structure if it be enteric fever. There is here no coating, for an interim sufficient has not been afforded for new epithelial growth and bacterial lodgment on the papillae

processes, nor is there much food passing over the tongue to lend to the coating. This is the dry relapsing tongue.

Primarily a coated tongue would suggest nonuse, as it is by its constant rubbing against the hard palate; by the passing over its surface masses of food in the act of chewing, that epithelial cells accumulated to entrap bacteria and collect food residua, are otherwise kept wiped off. Hence on seeing a coated tongue an anorexia, or a forced abstinence, might be presumed. If the lining is unilateral an ulcer might account, or carious or missing teeth on the coated side, or yet a neuralgia of the lingual branch of the third nerve; any of these could account for a one-sided furring. But the clinician sees the tongue where there is appetite-where food is daily masticated and digested; where the teeth are sound, when it is lined with a heavy brown fur-without dryness; the patient thinks he is bilious; a cholegog cathartic given often produces a more marked furring, presumably because of its irritant effect upon the stomach and duodenum; after which the coating disappears.

It may be, as is maintained by many, that the coated tongue is only from nonuse, and can have but indirect significance to the clinician; it may be, as Dr. Dickinson (Lumlean Lectures, London, 1888,) avers, that the appearance of the coating-the parasites, which he claims form the bulk of the fur-is of secondary interest; that they are "the fringe of the garment and not the garment itself;" these things may be, and with reason; but it is not denied that this coating is of significance, though secondary; and we know that it is easily seen; is common to certain presumable conditions; that its changes attend varyings in the given condition. Because of these things, we may not lightly ignore it. It is worthy to be called a symptom, which, taken alone, may be, and too often is,

unreliable, but which, with other attendant signs and phenomena, does have clinical significance. "It is by the aggregate and succession of symptoms that disease is detected" (Dunglison). Faulty elimination of the products of metabolism may be mirrored on the tongue, which accumulates its old epithelium and is slow to throw it off. Changes in the blood affect its coating by lessening the gland activity and diminishing the watery element, the secretion is viscid and holds the cells, adds food detritus and encourages multiplying of bacteria. When all gland function is stopped the moisture is quickly evaporated, the lining dries; the tongue itself becomes shrunken and board-like. These changes, most often met in typhoid fever, are common to the typhoid state, which may supervene in any acute infectious disease as an expression of the toxic state of the system.

Diseases of the tongue and their effect on its appearance have not been dealt with in this paper. From the study of its clinical aspect in other disorders we may safely conclude: that it is an aid to diagnosis, but of inconsistent value; that its greatest value as a symptom is to indicate the progress and promise in the given disease. The observant physician's greeting, "Put out the tongue," implies "How are you to-day?" and the protruded tongue, though silent, is expected to make reply.

BIBLIOGRAPHY.

Dis. of Tongue-Butler.
Normal Histology-Piersol.

Phys. Diagnosis-DaCosta.

Diagnostics Int. Med.-Butler.

Anatomy-Gray.

Practice-Osler-Auder.

TYPHOID FEVER OF TWENTY-FIVE YEARS AGO: ITS TREATMENT COMPARED WITH THAT OF TO-DAY.

BY J. L SELMAN, M.D., DOUGLASVILLE.

The subject that we shall speak of to-day, that of typhoid fever, has been so ably and forcibly presented to this Association by men of deep thought and resource at almost every meeting that we have had, that there is but little more to be said that can be of any or very much interest to the profession.

There can be no doubt that this disease has prevailed extensively from very remote periods, but its authentic history, like that of many other infectious diseases, is of quite recent date. Frederick Hoffman in Germany, Huckman in England, and others, all describe cases of typhoid fever with such exactness as to leave no doubt as to the identity of the disease.

It still remains, however, for the nineteenth century to define its distinguishing characteristics. No sooner were the problems of the semiology and mythology settled, and the conclusion generally accepted than the equal importance of the etiology of typhoid fever took their place and a discussion arose which has not been fully settled yet. The medical world has been, and still is to a certain extent, divided into two parties-those who hold that typhoid fever is not only a distinct disease, but is a specific disease having its specific poison, which is only produced by itself and only reproducing itself, but there