1631

third book of the Odyssey when Nestor sent for the familygoldsmith to prepare gold adornments for the sacrificial

heifer’s horns. When, however, the same ancient Greek wasin an enemy’s country he positively wallowed in cattle

slaughter and ate hugely of the slain.l I We cannot see thatit is less demoralising to slay a hen than to slay a sheep, if,indeed, either be demoralising. But two things are certain:one is that many persons at Christmas, to say nothing ofother seasons, eat too much meat and the other is that livebeasts should not be exhibited among dead ones. Moreover,as germane to the subject, the grossly overfat cattle and pigsof the Cattle Show are neither wholesome for food nor objectsof beauty. -

TYPHOID FEVER IN THE AGED.

IT is generally believed that typhoid fever is very rare inthe aged. But recent observations appear to show that its

rarity has been exaggerated. In 1898 Dr. Manges, an Americanwriter, stated that of 3634 deaths from typhoid fever

occurring in New York from 1887 to 1896 96 (or 2 - 6 percent.) were in persons over the age of 65 years, and 414 (or11 - 3 per cent.) were in persons aged between 45 and 65 years.He thought that the disease was not infrequent in the agedand was often overlooked. Professor William Osler foundthat in 829 cases of typhoid fever admitted into the JohnsHopkins Hospital up to May, 1899, six of the patients werebetween the ages of 50 and 60, and six were over 60 years.He agreed with Manges that, as the course is often atypical,cases are overlooked. In the American Journal of theMedical Sciences for October Dr. A. S. Hamilton has

published an important paper on the subject. In continua-tion of the work of Dr. Manges he has collected statisticsfrom the Health Departments of Chicago, Boston, and

St. Louis. Out of a total of 3885 deaths from typhoidfever in these cities in the years 1897-1901, 369 (or 9 5 percent.) occurred in persons over the age of 50 years. In an

outbreak of typhoid fever at the Hospital for the Insane atIndependence, Iowa, he found that a number of persons welladvanced in years contracted the disease. Out of a total of

183 cases, 27 (or 14 3 per cent.) occurred in persons over 50years of age ; of these 6 occurred at the ages of 50 to 54, 8 atthe ages of 55 to 59, 9 at the ages of 60 to 64, 1 at the ageof 65, 2 at the age of 71, and 1 at the age of 78. As a largeproportion of the patients in the hospital were advanced inyears these figures cannot be taken as showing the liabilityof the aged in general to the disease. However, in twocottages and in two wards of the hospital in which the

disease was particularly prevalent the ages of the inmateswere taken into account with the following results. This

portion of the hospital contained 318 men, of whom 65 (or20’44 per cent.) contracted the disease. At ages from 20to 29 years there were 55 patients, of whom 15 (or 27 percent.) contracted typhoid fever; at 30 to 39 years, 89, ofwhom 24 (or 27 per cent.) were affected ; at 40 to 49 years,78, of whom 17 (or 21’ 7 per cent.) were affected; at 50 to59 years, 44, -of whom 5 (or 11’ 3 per cent.) were affected ;at 60 to 69 years, 41, of whom 2 (or 4’8 8 per cent.) wereaffected ; at 70 to 79 years, 8, of whom 2 (or 25 per cent.)were affected ; and at 80 to 89 years, 3, of whom none wereaffected. The average age of all the patients was

43 years, while the average of those who contracted

typhoid fever was only a little less, 33’ 9 years.The symptoms of typhoid fever in the aged differ from thosein younger people. In three of the cases observed at the

Independence Hospital the degree of aberration was so greatthat the diagnosis would not have been made but for theWidal reaction. All the cases differed widely from one

another, so that it would be difficult to construct a type oityphoid fever in the aged. However, in general it may bE

1 Iliad, passim.

said that the cases differ from those in younger people in thefrequent absence of certain ordinary signs-the type of fever,rose spots, enlargement of the spleen, and epistaxis. On the-other hand, complications which are at times misleading indiagnosis are likely to be marked. In only one of the 27’cases was there any tendency to the production of the typicaltemperature chart. The ordinary diurnal variation was muchincreased. In almost every case the temperature was remittent ;’,in seven cases it was even intermittent, reaching normaltwice or thrice during the first week. In five cases the highesttemperature recorded was between 105° and 105’ 8° F. ; in15, between 104° and 105° ; in five, between 103° and 104° ;.,and in one it was 102’6°. The average temperature wasmuch lower than this. Usually it did not rise above 102° or103°. With a low grade of fever lysis occurred unusuallyearly. The temperature generally was normal or almostnormal by the eighth to the eleventh day, but it rarelyremained so and there was a tendency to prolQngation ofslight fever. In only three cases did the temperature-remain normal after reaching it; in seven cases slight-variations extended over a considerable period, and in 11-

there were in addition recrudescences. Chills and sweats.

seemed more common than in the young. In six cases there-were well-marked rigors. Disturbances of the circulationwere common; in 70 per cent. the pulse was described as" bad " at some time and in 39 per cent. it was intermittent.Disturbances of the respiratory system were common. In18 cases tympanites was marked, which was probably partlydue to flabbiness of the muscles.

THE CURABILITY OF CERTAIN FORMS OFSEPTIC MENINGITIS OF AURAL ORIGIN.

AT a meeting of the Soci6te M&eacute;dicale des Hopitaux ofParis on Nov. 15th M. Paul Laurens read an importantpaper on the curability of certain forms of septic meningitisof aural origin. He pointed out that the curability.depends upon the kind of microbe : streptococcic meningitis,is very grave ; in pneumococcic and staphylococcic meningitis.recovery is more common. He reported the following case.A boy, aged 15 years, was taken to hospital on Sept. 7th,1907, suffering from acute suppurative right otitis media.Paracentesis was performed, an abundant discharge of pusfollowed, and an occlusive aseptic dressing was applied.On Sept. llth there were vomiting, headache, vertigo,and horizontal nystagmus. The tuning-fork was heard<

through the bone, showing that the labyrinth was,

normal. The tympanum was badly drained. " Laby-rinthisme," which frequently occurs in young subjectssuffering from otitis media, with retention was suggested.However, lumbar puncture was performed. The liquid was-clear but gave on centrifugalisation a slight deposit com-posed of red corpuscles and some polynuclears. Cultures on-

gelose remained sterile. Half an hour after the puncture thevertigo and nystagmus had much diminished. A large open-ing was made in the membrana tympani. On the following,day the temperature was 102’ 4&deg; F., headache was severe,there were photophobia and spasm of the facial muscles, andthe nystagmus was increased. Vertigo was incessant evenwhen the patient was in bed. Kernig’s sign was well

marked. Lumbar puncture yielded clear liquid which oncentrifugalisation furnished a slight deposit composed almostentirely of polynuclears. These were in manifest histolysisbut to direct examination showed no microbes. However,the changes in the polynuclears caused septic meningitis tobe diagnosed without waiting for the results of culture. An

intravenous injection of four cubic centimetres of a 1 percent. solution of collargol was given and was followed infive hours by a violent reaction-anguish, rigors, and a tem-perature of 103 ’ 3&deg;, but on the 13th the temperature fell to >100’4&deg; and the vertigo diminished. The diffuse nature of.