such as albumen, fibrin, casein, musculin, etc., gluten, legumen, etc.; of the vegetable kingdom, organic, non-nitrogenous principles, such as starch, sugar, and fats, and a few inorganic salts. The amount and character of these foods necessary to repair waste will be subject to ever-varying circumstances, such as climate, the amount of muscular work performed, etc. The character of the various ferments indicate the character of food and quantity to be taken when man is in a physiological condition. Man is, unfortunately, however, not always in a physiological condition.

The normal supply of these ferments depends upon individual vigor and force, and if these be impaired, then pathological fermentation is the result. As man leans to the carnivora, so it seems that the tissue meats should constitute the great bulk of his food, as being more easily digested and appropriated for the repair of wasted tissue and the production of force.

It

Man injects with his food the spores and germs necessary to carry on all the great fermentative processes. In the healthy process these germs are converted with the food, and no harm is done the individual; but when from any cause digestion is impaired, these germs find the very conditions favorable to their multiplication, and there is consequently diseased action. would seem, therefore, the part of wisdom to eliminate from the dietary in sickness such articles as are most liable to take on pathological fermentation. For this reason starch and the sugars should be interdicted in sickness to a great extent; for if this is not done, elimination will have subsequently to take place through the outlets of the organism.

It is just here that the artificially digested and prepared foods have their appropriate sphere. Necessity being the mother of invention, man by his manufacturing art steps in and proposes to furnish these various ferments ready to nature's hands. Thus from the seedling the chemist secures diastase, from the stomachs of animals pepsin, while the pancreas yields up its pancreatin.

Pepsin acts in an acid medium, and exercises its solvent powers upon albuminoid substances only; consequently, the use of the pepsins for the digestion of the non-nitrogenous elements of

food would be extremely foolish, and vice versa with pancreatin, which will not act in an acid medium.

The various prepared foods upon the market have, as Fothergill says, been usually constructed upon the "shot-gun principle," with a view that when one misses the other will hit. These foods, no doubt, are a long step in advance of the crude material.

The great objection to the use of the peptonized foods is their unpalativeness; by smell and taste they outrage the sensibilities of the sick; therefore, it would be well in many cases to use them as a dernier resort, when other means, such as the supplying of the artificial ferments as medicines, have failed. Many persons use predigested foods when there is no necessity for their The stomach thus becomes pauperized and encouraged to indolence of action. It would seem that the true place for the peptonized foods is where there is great gastric enfeebleness, and after other means, such as a judicious selection of foods and the use of the artificial ferments, have failed. That great gastric irritability is an indication for their use has not been proved.

use.

The lists of predigested foods upon the market, of greater or less merit, are legion. The idea will readily suggest itself to the reader that age will necessarily deteriorate them. Hence, to be effective, they should be, as a general rule, extemporized, full directions for which may be found in works upon dietetics.

A broader knowledge of the chemical destination of foods and their adaptability to the ever-varying conditions of health and disease, the effects of cooking, and the subtile changes accompanying the various stages of digestion, is much to be desired. It is a want of such knowledge that has whitened thousands of hill-sides with the tombs of our "little dead," and hampered true medicine in her onward march of progress.

TYPHOID FEVER.1

BY J. W. Renfro, M.D., HARRISBURG, ILLS.

MR. PRESIDENT AND GENTLEMEN :-In the selection of typhoid fever as the subject of this paper, I do not flatter myself with the vain thought that I can add any thing to the literature of the day on this important topic, nor do I presume for a moment that I shall say any thing that will enlighten the minds of the learned and experienced body of practitioners to whom this paper is addressed, but hope it will be an incentive to a discussion which will be beneficial to all.

Typhoid fever occurs in every inhabited country in the world. Its victims are of all classes of society, all races, colors, sexes, and ages, attacking alike the rich and the poor, the citizens of densely crowded cities and the denizens of rural districts.

Etiology.-Some authorities say that typhoid fever never occurs unless it is communicated through the medium of the excreta of a typhoid fever patient. Others, on the other hand, contend that it may be, and often is, produced by foul air or water which has been contaminated with the filth and effluvia from privies, cess-pools, barn-yards, etc. That water thus contaminated is a 'frequent source of diarrhoea, and perhaps other diseases of the alimentary canal, is doubtless true, but that it ever causes typhoid fever is extremely doubtful. But there is no doubt now that the alvine discharge of a typhoid fever patient, after a period of time, will, by communicating with wells or water supplies, infect a whole family, neighborhood, town, or city.

In support of this statement I might refer to several epidemics, but will only call your attention to one, which occurred at Plymouth, Penn., in April and May of 1886, and made the subject of two articles in the Medical News by Dr. L. H.

1A paper read before the Saline County Medical Association, Dec. 20, 1886.

Taylor. In this epidemic about one thousand people were sick with the fever and one hundred or more died. Near the source of the stream of pure mountain water from which the town of Plymouth was supplied was a typhoid fever patient who was taken sick with the fever in January, and the fever continued many weeks, with one relapse; in March he had hæmorrhage of the bowels. His dejecta were thrown out near the bank of the stream, and the temperature being below the freezing point until about the first of April, when there was a thaw, and all this accumulated poisonous dejecta was washed into the stream and distributed to the unsuspecting inhabitants of Plymouth, and in a very short time quite a number of the citizens of the town were prostrated with the fever.

The stage of incubation is supposed to be about fourteen days, but is sometimes very much shorter, owing, perhaps, to the virulence of the poison, or more properly to the number of baccilla taken into the system. We have the history of twenty schoolboys who were attacked on the second day after inhaling the poison of a cess-pool which had been dammed up for twenty years, and perhaps contained the germs of typhoid fever.

Morbid Anatomy.—The principal lesions in typhoid fever are the changes which take place in the agminated and solitary glands of the intestines, more especially those of the lower portion of the ileum. These glands pass through four stages during the progress of the disease, viz.:

1. The stage of medullary infiltration.

2. The stage of softening or sloughing. 3. The stage of ulceration.

4. The stage of cicatrization.

Each one of these stages is supposed to occupy about a week's time.

The medullary infiltration, upon which the enlargement of the gland depends, is due to proliferation of cellular elements; this proliferation may be limited to the follicles, or it may extend to the cellular tissue and to the adjacent mucous membrane. In the mildest form of the disease the changes may not advance beyond this stage, resolution taking place by the absorption of

the debris, which is caused by the breaking down of the morbid material. But the large majority of cases advance on through all the stages above named until they end in resolution or in death.

As before stated, the glands in the lower portion of the ileum, near the ileo-cæcal valve, are mostly affected. In one case in which I witnessed a post-mortem examination of a patient who died during the fourth week of the fever, the ileum from near the ileo-cæcal valve was sphacelated, and a little further above were large ulcers which had broken down the mucous and muscular coats of the intestine.

Symptoms.-The severity or mildness of the symptoms of typhoid fever in the prodomic stage depends, according to my limited observation, upon the virulence of the poison taken into the system. Let me here call your attention to the mildness which generally attends its initiatory stage as met with in sporadic and isolated cases in Saline County. The first symptoms of this disease are aching in the limbs and back, malaise, lassitude, thirst, and anorexia. These symptoms may continue sometime before the patient has fever, but they are usually followed in two or three days by fever, with morning intermissions and evening exascerbations. During the first week the patient may not be confined to bed; in seven or eight days, however, the symptoms have increased in severity until he now has fever all the time. The skin is hot and dry, but occasionally breaks out in perspiration. There is tenderness, sometimes attended with a gurgling sound, in the right iliac fossa. The tongue, which was at first red all around the edges, with a little streak of brown fur in the middle, extending from its base to within a half inch of its apex, soon becomes covered with this brown fur, which becomes very dry and thick and is shed in flakes, and is soon replaced again, becoming darker each time until it assumes the character of a dark brown crust, which is usually accompanied with sordes on the teeth. In some few cases there is very little change from the normal appearance of the tongue throughout the disease. The bowels are generally constipated in the prodromic stage, but are usually attended with diarrhoea as the dis