or its equivalent of methylated liquids, escape permanent damage, i.e., most persons are, to some extent, immune to serious poisoning by small quantities of methyl alcohol, this is by no means true of larger quantities; nor does it, by any means, prove the immunity of every person from poisoning by very small quantities. Until the experiment has been made, nobody can be assured of safety to eyesight from the ingestion of much smaller amounts of the poison. There are many well-authenticated instances in which the drinking of a couple of teaspoonfuls of wood spirits was followed by blindness. The intoxication of persons from inhalation of the fumes of methylated alcohol is another example of poisoning by small quantities of the intoxicant, because the actual bulk of liquid so absorbed by the lungs and skin must be comparatively small. The cumulative quality of methylism has been referred to by several writers. This matter will be further discussed in speaking of the pathology of the subject. Meantime our investigations undoubtedly demonstrate that in many instances no marked poisonous symptoms were noticed until twenty-four hours or longer, after the last of a number of doses, (usually small "drinks") had been taken. Unlike most poisonous agents that are responsible for acute symptoms, these may not much disturb the patient for a relatively long interval after the ingestion of the poison. Indeed, it may be set down as a rule that, except in persons exhibiting an idiosyncrasy against wood alcohol, or unless a large dose of the poison is drunk within a few hours, not only may the severe abdominal symptoms, the cardiac and nervous collapse and the blindness be postponed, but even the fatal termination has, in some instances, been delayed for several days. This information, derived from the histories just published, demonstrate the fact that there is danger, albeit an unknown degree of danger, to life and eyesight attending the ingestion of any amount of wood alcohol. Moreover, while the acute, unmistakable symptoms of the ordinary forms of intoxication enable us to recognize them at once, there can be no doubt but that much. smaller quantities, taken into the system, as methylated quack remedies, adulterated foodstuffs (Jamaica ginger, "lemon extract," essences), or the secret dram drinking of bay rum, cologne water, etc., may, in persons not immune, injure the digestion and permanently damage the vision. There are very few poisons that more distinctly exhibit the selective character of the intoxication than wood alcohol. It has again and again been demonstrated that a minority of those who imbibe methylated fluids suffer no permanent damage from them. In other words, many people are practically immune to moderate doses of methyl alcohol. In most cases where small doses are taken, serious intoxication means that there is in the poisoned individual an idiosyncrasy against this agent. It is owing to this fact that in times past many perfectly sincere observers asserted, and interested parties loudly proclaimed, the innocence of methyl alcohol. During the trial of the Baltimore suits against Gilbert & Co. a dramatic incident occurred, based on this belief. A chemist drank a quantity of methylated spirits in open court. Of course, we now know that, although this was a dangerous act, the chances were greatly in favor of the witness, especially if at the time his stomach were full of food, or if he took an emetic shortly after the draught of wood alcohol. Prof. W. A. Puckner, in the Western Druggist for December, 1897, wrote: 66 The only constituent of wood alcohol likely to be present in sufficient amount to be poisonous is acetone, and, since methyl alcohol is comparatively free from this, the preparations now in the market are presumably also free from the poisonous properties ascribed to wood alcohol." Supporting this proposition, he took internally single 30 c.c. doses of a commercial wood alcohol containing about 0.5 per cent. of acetone, and experienced no unpleasant results therefrom. "Further doses of 15 c.c. taken at intervals of thirty minutes until 90 c.c. had been drunk, left, the body temperature normal, at first somewhat accelerating, later slightly depressing, the pulse, i.e., producing the characteristic effects of ethyl alcohol." On the other hand, Dr. Reid Hunt,* of Johns Hopkins, showed that, in experimenting on dogs, the latter were all killed by doses of Columbian spirits and other fluids containing methyl alcohol, while animals survived the same and larger quantities of ethyl alcohol and pure acetone. In considering the actual poisonous agent in the methy! alcohol of commerce, one must not forget the secondary organic compounds formed in the intestines and in the blood. It is quite likely that these play an important rôle in the damage inflicted on the system. Those interested in this subject had better write to Dr. Buller for the address, or read my article in The Daily Star, Toronto, which, at length, with notes, deals with this subject, and cites several cases. *Toxicity of Methyl Alcohol, 1903. Selected Article. THE BRADSHAW LECTURE ON THE TREATMENT OF ENTERIC FEVER.* BY F. FOORD Caiger, M.D. (LOND.), F.R.C.P. (LOND.) Mr. President and Gentlemen,-My first duty is to express my grateful appreciation of the honor which the President has done me in deputing me to deliver this lecture. In my choice of a subject I have been guided by the President's wish that it should. be one more or less identified with my daily work, and I have, therefore, selected the treatment of enteric fever as seemingly not inappropriate. During recent years a great deal has been said, and still more written, as to the treatment of typhoid fever, and that by some of the most eminent members of our profession. It is not unnatural, therefore, that I should feel some diffidence in bringing the subject before you on this occasion; and yet, when one reflects that our case-mortality to-day remains at a height of more than 15 per cent., and that in this country alone some five or six thousand persons annually die from the disease, I feel that it is not, perhaps, without some justification that I venture to recall your attention to the important question of its treatment. To attempt to deal at all exhaustively within the time at my disposal with a subject as wide as that of the treatment of enteric fever would be manifestly impracticable, for, in addition to a discussion of numerous measures of a directly remedial character, it would involve the careful consideration of various points of no less importance in connection with the dietary and the nursing of the case. Moreover, the subject is one which has, perhaps, offered a wider field for discussion and been a source of greater difference of medical opinion than in the case of any other disease. I propose, therefore, to confine my remarks entirely to the field of therapeutics, with special reference to various measures which, as the result *Delivered at the Royal College of Physicians of London on Nov. 15th, 1904. of my experience, I have come to regard as worthy of some confidence. From a therapeutic point of view, it may be stated broadly that the treatment of a case of enteric fever will probably be conducted on one of two well-recognized lines—an active remedial method, or a passive, or so-called expectant, method, each of which has its firm adherents. But whether we favor the exhibition of remedies having for their object a direct interference with the natural course of the disease or whether, as is so much the fashion to-day, we adopt an expectant attitude and are content to restrict our efforts to combatting individual symptoms in the event of their assuming a threatening aspect, and to relieving any complications which may arise during the course of the illness, the fact must never be forgotten that the treatment of enteric fever is not merely a matter of therapeutics, but implies the general management of the case. Now, it may be asserted generally that our management of any case of serious illness is likely to be successful in proportion as it is adapted to the special circumstances which characterize that attack, due regard being given not only to the underlying morbid process, of which certain of the symptoms are the recognized expression, but also to the personal factor which in some instances contributes so largely to the general aspect of the case; and to this rule enteric fever is no exception. Experience clearly indicates that what is best for one patient may not necessarily be so for another, and that the best results will be achieved, not by a slavish adherence to any particular method of treatment, to the exclusion of others, but by the adoption of such measures as seem best adapted to the idiosyncrasy of the individual patient and the particular type of his attack. The methods of treating enteric fever by means of remedies which are assumed to be capable of exerting a direct controlling influence over the natural course of the disease may be appropriately referred to as either (1) specific, (2) antipyretic, or (3) antiseptic, according to their conception and to the nature of the agents employed, and they may conveniently be discussed under these headings. 1. First, as to specific treatment. The remarkable success which has attended the treatment of diphtheria by the injection of antitoxic serum, and in less degree that of tetanus, not unnaturally encouraged the hope that a curative serum might be prepared which would prove equally efficacious in the case of typhoid fever. But, unfortunately, such favorable anticipations have not been realized. In the case of the two former diseases, the serum of the horse, which has been successfully immunized against these infections, is found to be highly antitoxic, besides possessing some anti-bacterial power. In the case of typhoid fever, however, the serum of a horse, after repeated inoculations with the virus, though possessed of anti-bacterial properties, as in the case of diphtheria and tetanus, is found to be practically devoid of any antitoxic value, and consequently useless as a curative serum. Until a serum can be produced which is antitoxic, in addition to containing anti-bacterial substances, it would seem that all attempts to confer a specific passive immunity in enteric fever must, as in the case of cholera, apparently be doomed to failure. It should be mentioned, however, that Chantemesse claims to have produced a serum with which a remarkable success in the treatment of enteric fever is said to have been achieved. Speaking at the Seventh French Medical Congress, held last month in Paris, he stated that of 545 cases of the disease which had been treated in his wards at the 29th Bastion, between April 1st, 1901, and Oct. 1st, 1904, only 22 proved fatal, representing a mortality of 4 per cent. Planté and Foucauld, with the same remedy, were reported in January, 1903, to have treated at the Marine Hospital of St. Mandrier, 151 cases with 13 deaths, a mortality of 8.7 per cent. The two series together comprise 696 cases, with a fatality of 5 per cent., a success which is really phenomenal. · As to the nature of this serum there is at present some uncertainty. For its preparation a horse is immunized by repeated inoculation with toxic products of the typhoid bacillus obtained by special methods of cultivation. The serum eventually acquires curative properties, but the process is a slow one, requiring a good many months for its accomplishment. Chantemesse states that the serum retains its properties unimpaired by keeping, an observation which suggests that its mode of action is not a bactericidal one. On the other hand, the fact that its injection is often followed by definite, though not prolonged, constitutional disturbance, and the very remarkable fact, as stated by Chantemesse, that the more seriously ill the patient is, and the more advanced the disease, the smaller should be the injection, seems hardly compatible with the action of a serum which is merely antitoxic. It has been suggested by Dr. A. E. Wright that its curative properties may be explained on the assumption that an active immunity is conferred on the patient as a result of the transference from the horse of unneutralized bacterial poisons, which act as vaccines when introduced into the human organism. It is to be regretted that more precise information as to the |