Hookworm," which was discussed by Drs. Sshnauss, Smith, Charlton, McArthur, Slack, Westmoreland, Thrash, Battey, Key, Goss, Harris, Kenyon, and in closing by Dr. Fort.

Dr. W. S. Goldsmith, Atlanta, read a paper on "Drainage in Suppurative Conditions About the Abdomen," which was discussed by Drs. Westmoreland, White, Fowler, Norton, Battey, Holmes, McRae, and in closing by the essayist.

FIFTH SESSION.

THURSDAY AFTERNOON.

Drs. T. P. Waring and E. R. Corson, Savannah, read a paper on "Hereditary Multiple Osteomata.”

Dr. Hugh M. Lokey, Atlanta, read a paper on “Headaches and Neuralgia Due to Diseases of the Nose and Accessory Sinuses," which was discussed by Drs. Harbin and Stirling.

Dr. Edward G. Jones, Atlanta, read a paper on "Gastro-Jejunostomy-Report of Cases," which was discussed by Dr. White.

Dr. J. L. Frazer, Fitzgerald, read a paper on the "State's Attitude to the Drug Habitue."

Dr. Theodore Toepel, Atlanta, read a paper on "Treatment of Sprains," which was discussed by Drs. Aycock, Fowler, McRae, Standifer, Armstrong, and in closing by the essayist.

Dr. Thomas H. Hancock, Atlanta, read a paper on the "Treatment of Crushes of the Extremities."

Dr. W. B. Armstrong, Atlanta, read a paper on the "Anatomy of the Peritoneum and Gastro-intestinal Tract from the Standpoint of Development," which was discussed by Drs. Jones, Andrews, McRae, and in closing by Dr. Armstrong.

SIXTH SESSION.

FRIDAY MORNING.

Dr. W. A. Norton, Savannah, read a paper on "Fractures of the Skull." Discussed by Dr. White.

Dr. A. L. Fowler, Atlanta, read a paper on "Tumors of the Bladder," which was discussed by Drs. Ballenger, Westmoreland and Battey.

Dr. C. R. Andrews, Atlanta, read a paper on "SacroIliac Disease," which was discussed by Drs. Paullin, . Armstrong, Toepel, and, in closing, by the essayist.

Dr. J. H. Crawford, Atlanta, presented a paper on "Two Interesting Cases of Mastoiditis."

Dr. Ralston Lattimore, Savannah, read a paper on "Significance of Arterial Hypertension-Its Treatment," which was discussed by Drs. Slack, Charlton, Armstrong, Harris, McHatton, Murphey, Andrews, Ballenger, Paullin, and in closing by Dr. Lattimore.

Dr. Lawton Hiers, Savannah, read a paper, “Presentation of a New Eye Dressing." Discussed by Drs. Stirling, Calhoun and the essayist. The session then adjourned.

A RESUME OF 148 CASES OF TYPHOID FEVER, WITH REFERENCE TO THE EFFICACY

OF THERAPEUTIC FASTING.

BY R. M. HARBIN, M.D., ROME.

Autointoxication and inanition are the Scylla and Charybdis of a typhoid patient, and the physician who can pilot the charge through this narrow channel of safety should be accorded a high degree of therapeutic skill.

For the treatment of typhoid fever a specific remedy has not been discovered, and the consensus of opinion is that medicines have but little more than a contributory effect in the management of this disease. So the drug treatment may be eliminated altogether from this discussion.

The process of using bacterial vaccines for hastening the process of immunization by increasing the phagocytic property of the blood, thus raising the opsonic index which takes place in a normal case of typhoid fever, is rational and scientific, and deserves a more extended application. In other words, the processes of nature are expedited by this method.

At present it is universally agreed that the food factor in the management of a typhoid patient is the most important practical question to be solved. In this day of progressive medicine, there is a tendency to wander away from convictions that have been evolved from years of bedside study. It is reasonable to suppose that the newer methods of research would reveal certain fallacies that have resulted from clinical observations, but it is unrea

sonable to admit that old clinical conclusions could be displaced by bedside studies of the present day, for it is doubtful that clinical observers of recent years are in any way superior to our medical forefathers.

Bacteriological investigations have not made void many of the old clinical methods of management of typhoid fever, but on the other hand, have enabled us to confirm and perfect the technique of treatment given by our predecessors, and it is safe to say that the lowered mortality rates are now more due to that factor than to any other cause, excepting possibly the serum treatment. Of course, there has been great advance in prophylaxis.

Our apology for offering these observations is that the heavy mortalities from the accepted form of treatment of typhoid fever are unwarrantably high. One of the best known surgeons in America a few years ago made the statement publicly that in one year a number in his family connection had died from typhoid fever, and had had the best medical services available; and further said if he were to contract the disease he would prefer that some intelligent country physician should manage the case. Such comments are not common.

As this resumé is offered from the standpoint of a clinician, it is well to refer to certain clinical facts relating to this disease.

Typhoid fever is a disease of early adult life, the average age in this series of cases being twenty-one years. Extremes of age show less susceptibility, as do also the anemic.

Robust individuals seem to be more susceptible, and furnish the more violent types of the disease, and is probably due to a peculiar susceptibility, and to the fact that more infection is consumed. Of the total number there was 27% of cases classed severe between the ages of twenty and thirty years, while the per cent. of severe cases

among others was 12.4. There was a greater amount of toxemia associated with those exhibiting gastro-intestial symptoms, showing a direct relation between the extent of pathognomonic lesions and the constitutional symptoms. Of the fifty-seven severe cases, forty-five, or 78.7%, gave marked gastro-intestinal symptoms, while in the mild cases the per cent. was 15. We have similar conditions in diphtheria, in which the extent of pathognomonic lesions, as a rule, bear a direct relation to the systemic disturbance. The toxin of the bacillus typhosus is liberated by the disintegration of the organism, and takes place more rapidly in the human organism than in culture media. The bacilli found in the feces represent those that have escaped absorption, and are probably a small per cent. of those existing in the digestive tract. "In typhoid fever, the bacillus first found its way from the alimentary tract to the lymphopoietic system, including the spleen, where it developed chiefly, and from it invaded the blood stream. They thought it doubtful if the bacillus multiplied in the blood, but believed that its presence there represented simply an overflow from the lymph organs.' So we would conclude that the battle-ground of treatment lies in the vicinity of the small intestines.

More characteristic symptoms are displayed in diarrheic cases, while the opposite is true of the constipated cases. A contrast of symptoms may be noted in the second week, where watery diarrhea exists, and a week later, when the bowels become constipated; yet the patient has been taking the same food and running the same temperature while the en semble of symptoms has markedly changed. The excessive activity of purgatives is evidence of contraindication to this class of remedies, and as diarrheic

Editorial, Journal A. M. A., August, 1903.

2 "Bacteriology of the Blood in Typhoid Fever." Coleman & Buxton: Med. Record, March 30, 1907.