that infection from the urine from typhoid patients plays a great rôle in the epidemiology of the disease. Perhaps it would be better to say that the danger from urinary infection in typhoid fever is being more and more recognized.

Easton first reviews the subject of typhoid bacilluria and its treatment with urotropin, quoting at some length the results obtained by Richardson, Gwyn, Chichold, Walker, Horton-Smith, Ehrmann, Gordon, Cammidge, Brown, Griffith, and others.

Richardson (Boston Medical and Surgical Journal, February 5, 1903) drew the following conclusions regarding the presence of typhoid bacilli in the urine:

1. Typhoid bacilli are present in about 21 per cent. of individuals affected with typhoid fever.

2. The bacilli when present are usually in pure culture, and their number is frequently enormous-many millions in each c. cm. of urine.

3. The invasion of the urine by the bacilli takes place in the latest stages of the disease. Unless measures are taken to remove the organism they persist frequently for weeks, occasionally for months, and rarely for years, and thus constitute a danger to the patient himself (cystitis and possibly orchitis and epididymitis) and, what is much more important, a grave source of danger to the public health.

4. The necessity for the rigid disinfection and supervision of typhoid urine is apparent.

5. In urotropin we have a drug which will in the vast majority of cases remove typhoid organisms from the urine not only in the cases of simple bacilluria, but also in those in which cystitis has resulted. Very rarely an obstinate cystitis may require the use of vesical irrigations; very infrequently a case will be seen in which the use of urotropin is followed by hematuria. In such cases the drug should be omitted and irrigations of the bladder substituted. The subject in its relation to the public health is of the utmost importance. In any opinion it should be a fixed rule, and one vigorously enforced, that no typhoid convalescent be discharged as well until his urine has been proved permanently free from bacilli. In this way only can we prevent a considerable percentage of our typhoid convalescents from becoming unsuspected foci for the further distribution of the disease.

Easton, to demonstrate the practical value of these suggestions, has been giving urotropin (five grains three times daily) as a routine measure of treatment in typhoid at the Massachusetts General Hospital, the drug being omitted as soon as convalescence was established. In 46 of these cases repeated examinations of the urine were made from six to ten days after the discontinuance of the drug, and in none of these cases was there any growth of typhoid bacilli. In one of these cases the patient had a relapse of

the fever, and coincidentally with this the bacilluria returned.

Ten patients who had been treated by this method and discharged were examined the year subsequently, and in all cases the urinary examination was negative.

As to the toxicity of urotropin and the unpleasant effect which may be due to it, Easton has analyzed the 486 cases of typhoid fever in which urotropin was administered at the Massachusetts General Hospital. Most of these cases received from eight to ten grains three times daily, yet there were but three cases of painful micturition and two of hematuria.

Easton, from a consideration of the cases in the literature as well as his own long series of cases, draws the following additional conclusions:

I. Although urotropin may in very rare cases cause uncomfortable symptoms, it does not invalidate the use of the drug.

2. Urotropin is of less value in cases where an active inflammation of the bladder has occurred.

3. But as far as this series of observations goes the moderate use of urotropin throughout prevents cystitis.

4. Finally, the routine administration of the drug in all cases of typhoid fever would seem to be strongly indicated, for by such a course of treatment bladder complications are avoided, the urine made innocuous to those brought in contact with the patient, and it is possible to discharge patients who have been sick with typhoid fever in full belief that as far as the urine is concerned they will be harmless to the community.

*

THE CLINICAL EFFECTS OF ETHER ANESTHESIA ON RENAL ACTIVITY.

Pringle and Maunsell (British Medical Journal, September 9, 1905) give the results of their investigations undertaken with the object of determining clinically the influence of ether anesthesia on the secretion of urine, both as regards its quantity and its nitrogenous contents. The periods in which these determinations were made were: 1. Twenty-four hours, ending at 9 A. M. on morning of operation; 2. From 9 A. M. on the morning of operation till immediately preceding the administration of the anesthetic; 3. During the induction of anesthesia, ending with the abolition of corneal reflex; 4. First half-hour of complete anesthesia; 5. Second half-hour of complete anesthesia; 6. Third half-hour of complete anesthesia: 7. Six hours following anesthesia; 8. Twentyty-four hours following Period 7.

The bladder was emptied by catheter at the end of each period, and cases were purposely selected of such a type as to obviate as far as possible any special influence of the operation. All the cases. ran an aseptic course, and the urine tested before operation in each case was normal.

As regards the quantity in the various periods, taking the amount passed during Period I as the normal rate of secretion, the amounts passed during the various periods calculated in c. cm. per half-hour were as follows: In all cases but one there was an increase during Period 2 accounted for by the nervous condition of the patient preceding operation; in Period 3 there was in some cases an increase, in some cases a decrease, these results agreeing with those obtained experimentally on dogs; in Period 4 all cases showed a marked decrease, the average rate of secretion being only 23 per cent. of normal; in Period 5 the average was only 13 per cent. of normal, and in Period 6 the rate shows a further decrease; in Period 7 the rate of secretion again rises, but it never reached normal, while in Period 8 a slight decrease in secretion was met with in every case. In the last period the small amount of fluid taken and the amount of fluid lost by vomiting may have had some influence on this diminution of secretion.

As regards the secretion of total nitrogen, which was determined in all cases by the Kjeldahl method, the following results were obtained: In Period 2 all cases but one showed an increase in nitrogenous excretion; in Period 3 there is in some cases an increase and in others a decrease, the average, however, being a considerable increase; in Period 4 there is a marked decrease in every case, the average being only 22 per cent. of normal; in Period 5 being but 11 per cent. of normal, while in Period 6 it is only 2.2 per cent. of normal; in Period 7 the rate of nitrogenous secretion again rises, the average being 64 per cent. of normal, while in Period 8 the average is 84 per cent. of normal.

These results agreeing, as they do, with those obtained on dogs by Thompson (British Medical Journal, March 25, 1905), show the marked effect which ether exerts upon the secretion of urine as regards quantity as well as nitrogenous constituents. The condition of renal activity appears to increase the longer the anesthetic is continued, and this, in turn, must exert a markedly deleterious effect upon the general metabolism and condition of the patient.

In a recent number of the Medical News is found an interesting review of an exhaustive essay on this subject by Bertier published in the Gazette des Hôpitaux July 8, 1905, the complete bibliography of the subject being carefully considered and digested. Bertier enumerates the following clinical forms: A. Reflex. (1) Diseases. of the stomach: liquids too hot or too cold, unchewed food, carbonated liquids, indigestion. It may be a troublesome accompaniment of cancer, ulcer, and hyperchlorhydria. In nurslings it indicates an overloaded stomach. (2) Affections of the pharynx, aphthae, abscess, esophageal spasm due to benign or malignant stric

ture. (3) Diseases of the peritoneum. Every time the peritoneum is irritated hiccough is apt to arise. It is less constant in the localized varieties. (4) Intestinal disorders, including dysentery, lumbricoides. (5) Diseases of the liver. (6) Diseases of the spleen, most frequently hypertrophy. (7) Genito-urinary disorders; above all affections of the bladder. (8) Uterine disorders. (9) Pregnancy; in this case due to toxemia, like vomiting. (10) Abdominal wounds. (II) Diseases of the respiratory organs, particularly diaphragmatic pleurisy and pneumonia. In the former it is the source of agonizing pain. It is seen in subphrenic abscess. In pneumonia it occurs on the fifth or sixth day, and is ordinarily very violent. (12) Mediastinal compression. (13) Pericarditis, in which it is a bad symptom. (14) Exposure to cold. (15) Affections of the peripheral nerves, as in sciatica. (16) Spinal disorders, as displacement of cervical vertebrae. B. Hiccough of central origin. (1) Hysteria. (2) Emotion; seen in neuropathic subjects, transitory, and sometimes occurring in the course of laughing or crying, when it is really a sobbing. (3) Chorea and epilepsy. (4) Intoxications; lead colic, nicotinism, alcoholism. (5) Autointoxications, as uremia. (6) Infections. The hiccough of typhoid fever has been most studied. Hiccough is also seen in scarlatina, scurvy, yellow fever, cholera, and hydrophobia. (7) Cachexias. Hemorrhages. (9) Death agony. (10) Bulbar diseases. (11) Cerebral affections.

(8)

In treatment the following have been used: A. Medicinal: Injection of morphine, valerianate of zinc, belladonna and camphor, belladonna plaster over the phrenics, bromides and belladonna, opium and chloroform, inhalations of chloroform, ether injection of pilocarpine, infusions of peppermint, musk, theriac and belladonna, cocaine and belladonna. B. Non-medicinal: (1) Peripheral irritation, causing inhibition of the motor phenomena. For this purpose the following have been used: Epigastric acupuncture, tickling of the pharynx, compression of the auditory meati with extension of the head, actual cautery, chloroform compresses on the epigastrium, epigastric ether pulverizations, raising of the hyoid bone, drinking slowly while pinching the nose, sinapisms, vesicatories, catheterization of the esophagus, tetanizing galvanization of the esophagus, pharyngeal irrigations with cold water, compression of the fists, compression of the cubital region, compression of the ball of the thumb with the little finger, a little salt or vinegar placed on the tongue, and thrusting the tongue systematically out of the mouth. (2) Increasing the oxygenation of the blood by means of 40 to 50 rapid and deep respirations. (3) Direct action on the phrenics; compression, galvanism, vesicatories. (4) Magnetism, applied to lower part of thorax. (5) Mechanical interference with movements of diaphragms; forcible manual compression of the diaphragm, forced expiration or inspiration, abdominal bandage, and suspension of respiration. (6) Cold baths and wet packs. (7) Suggestion in all its forms.

Editorial and Publishing Committee.

ALEXIUS MCGLANNAN, M.D. HENRY O. REIK, M.D.

JOHN RUHRAH, M.D.

Secretaries of the County Societies are earnestly requested to send reports of meetings and all items of personal mention and of local or general interest for publication addressed to Dr. Alexius McGlannan, 847 North Eutaw Street, Baltimore.

NOTICE TO COUNTY SECRETARIES.

THE publication committee is very anxious to have notices of the meetings of the county societies published in each number of the JOURNAL. To this end we ask again every secretary in the State to send in a report of each meeting of his society. These reports need not be very long, but should state the time and place of meeting, together with the program and discussions, and also a note of any changes in membership or officers.

Reports of this nature would add greatly to the interest of the section devoted to the affairs of the Medical and Chirurgical Faculty. The members of one county society would thus be enabled to see what their neighbors were doing, and a new interest thus be added to the important work of keeping the societies active and up to date.

A report of this kind could easily be written while the secretary was listening to remarks or papers, and would not take up any of his time outside of the meeting. We should also like to have the cards announcing meetings. We cannot always print notices of meetings in advance, as the material for the JOURNAL must be handed to the printer on the tenth of the month preceding the appearance of the publication. Such notices would, however, enable us to keep informed as to what the component societies were doing.