(whether of animal or organic life), and we have a condition of organism favorable to the development of a symptomatic continued fever, persistent and grave in proportion to the persistence and gravity of the modifying cause or causes.

Mucous irritation, interrupting digestion and nutrition, may originate nervous disturbances, persistent, though slight gastritis, especially if the epithelium of the stomach has desquamated, will often keep up a continued fever, which in many of its symptoms imitates the typhoid fever of Louis.

Should irritation and thickening of the mucous membrane of the duodenum obstruct the ductus communis and secreted bile becomes locked up in the gall bladder, absorption of bile follows, the tissues of the body are tinged by its coloring matter, and we then have a case of what is sometimes called catarrhal jaundice. Sometimes it is recognized under the name of atonic jaundice, and when there are numerous cases of it in a community, it is called epidemic jaundice. During the recent prevalence of influenza in and around Cisco, there were numerous cases of this form of jaundice—none fatal.

Where a morbific agent, whether epidemic or accidental, seriously irritates or inflames the jejunum or ileum, or both these sections of the intestines, a series of symptoms announce to the thoughtful and intelligent practitioner that he must be careful of his diagnosis. For it is of the gravest importance that he then satisfy himself whether he has a case of verminous irritation, acute sthenic or asthenic inflammation of the mucous lining, or a typical case of the typhoid fever of Louis. The heat of the abdominal wall, the soreness of the bowels and the indisposition at the outset to evacuate their contents even under the influence of ordinarily active cathartics, are some of the evidences that forbid the diagnosticating of typhoid fever.

Typhlitis, though most commonly sporadic, I have seen, during the prevalence of an epidemic of influenza, provoke a symptomatic continued fever of several days' duration.

I am satisfied that I have met with cases of colitis during the prevalence of an influenza, that kept up a continued symptomatic fever for from five to fifteen days, without the manifestation of any of those symptoms regarded as pathognomonic of dysentery, viz: tormina, ten esmus and bloody mucous discharges.

Dysentery, during the prevalence of an epidemic of influenza, is

by anti-periodics, we often see a continued symptomatic fever, more or less serious and of a greater or less duration, the causes and contingencies already enumerated, as factors of variation of gravity and duration of a fever originally symptomatic, being in this also of full power and force.

INFLUENZA

is a continued fever, the morbific cause of which varies in the intensity of its impressions at different times or seasons, and in its power of impressing different individuals. The morbific cause of influenza, next to vicissitudes of temperature, errors of diet, etc., is the most frequent provocative of abnormities of the mucous lining of the body. The synochus and synocha of our predecessors (the inflammatory continued fevers of their nomeclature), the former a more grave type than the latter, almost daily to be met with in practice where the country is open, and the non-crowded condition of population does not favor blood-poisoning, were no more nor less than the common continued fevers of the present day, whose varied phases have tempted the experienced and seekers after novelties in nomeclature to describe them as new diseases, and in the discussion of which the observations and experience of past ages are almost totally ignored. This is to be regretted, when it is considered that a large majority of the cases physicians are called upon to treat are fevers. While in our day pathology and therapeusis have made great advances, we cannot afford to neglect the study of the history of diseases. Every well proven fact in regard to them, whether observed by Hippocrates, Galen, Sydenham, Cullen, Chapman or Drake, may help us in diagnosis and treatment. How much soever we may boast (and with justice, too, we may do so,) of our superior knowledge of pathology, pathogenesis and remedial treatment, it can scarcely be denied that their observations of the phenomena and course of diseases, comprehended under the head of symptomatology, were most careful and accurate, and their records thereof most faithful.

THE SYNOCHA AND SYNOCHUS

of the fathers had their origin in the morbific cause of influenzas, or accidental or wilful failure to avoid those causes that tend to congest the skin and mucous membranes, or otherwise to interfere with or interrupt the healthy performance of their formations.

Now modify the mucous irritation or inflammation of any locality of the alimentary canal, or of the air or urinary and genital passages, by any cause persistently or gravely impressing the nervous system

(whether of animal or organic life), and we have a condition of organism favorable to the development of a symptomatic continued fever, persistent and grave in proportion to the persistence and gravity of the modifying cause or causes.

Mucous irritation, interrupting digestion and nutrition, may originate nervous disturbances, persistent, though slight gastritis, especially if the epithelium of the stomach has desquamated, will often keep up a continued fever, which in many of its symptoms imitates the typhoid fever of Louis.

Should irritation and thickening of the mucous membrane of the duodenum obstruct the ductus communis and secreted bile becomes locked up in the gall bladder, absorption of bile follows, the tissues of the body are tinged by its coloring matter, and we then have a case of what is sometimes called catarrhal jaundice. Sometimes it is recognized under the name of atonic jaundice, and when there are numerous cases of it in a community, it is called epidemic jaundice. During the recent prevalence of influenza in and around Cisco, there were numerous cases of this form of jaundice-none fatal.

Where a morbific agent, whether epidemic or accidental, seriously irritates or inflames the jejunum or ileum, or both these sections of the intestines, a series of symptoms announce to the thoughtful and intelligent practitioner that he must be careful of his diagnosis. For it is of the gravest importance that he then satisfy himself whether he has a case of verminous irritation, acute sthenic or asthenic inflammation of the mucous lining, or a typical case of the typhoid fever of Louis. The heat of the abdominal wall, the soreness of the bowels and the indisposition at the outset to evacuate their contents even under the influence of ordinarily active cathartics, are some of the evidences that forbid the diagnosticating of typhoid fever.

Typhlitis, though most commonly sporadic, I have seen, during the prevalence of an epidemic of influenza, provoke a symptomatic continued fever of several days' duration.

I am satisfied that I have met with cases of colitis during the prevalence of an influenza, that kept up a continued symptomatic fever for from five to fifteen days, without the manifestation of any of those symptoms regarded as pathognomonic of dysentery, viz: tormina, ten esmus and bloody mucous discharges.

Dysentery, during the prevalence of an epidemic of influenza, is

sometimes more frequent than at others—so frequent, indeed, as to be regarded and popularly denominated epidemic flux.

The epidemic cause of influenza, often impresses the muscular and other fibrous tissues; sometimes so generally as to provoke a case of rheumatic fever. If the impression is most profound upon the muscles involved in the work of respiration, an accurate knowledge of the physical signs of abnormities of the thoracic viscera, is necessary to the successful differentiation of the local rheumatism from pleurisy, bronchitis and pneumonia, when none of these phlegmasia exist, and to recognize them if co-existent.

In organisms (especially those of children) whose fibrous tissues are easily impressed by morbific influences, it sometimes happens that the meninges of the brain and spinal cord, especially the duramater, becomes inflamed. Exudations occurring on the surface of the duramater, and the inflammatory process extending to the underlying membranes and cerebral substance, we have cerebro-spinal meningitis. Should a considerable number of such cases occur, during an epidemic of influenza, the sensationalists announce the prevalence of spotted fever, a misnomer, if used to designate a specific idiopathic fever.

Sometimes under the influence of an epidemic morbific cause, as well as vicissitudes of temperature, catarrh is developed in some part or parts of the urinary and genital organs, which may provoke a form of continued symptomatic fever.

THE TYPHOID FEVER

of Louis (the enteric fever of Wood) is and has been a vexata questio, ever since Louis first described it, as a distinctly specific disease, characterized by a peculiar eruption, and inflammation and ulceration of the solitary and agminate glands of the ileum. I walked the wards of the Pennsylvania hospital for a year, when Gerhard, a pupil of Louis, Wood and Pepper, were demonstrating its existence, and while Chapman, the greatest authority on medical practice of his generation in America, was lecturing at the University to a class of five hundred students, in opposition to the theory of Louis, and asserting that the so-called specific typhoid fever was no more and no less than the typhus mitior of previous writers and observers. To the teaching of Louis I was a conscientious convert, and am convinced that Gerhard, in his wards and the dead house, demonstrated the truth of its existence beyond a doubt. In the wards where he made this demonstration, he acknowledged cases of genuine typhus corresponding to Chapman's description of typhus gravior.

Since that period the literature upon the subject of typhoid fever has grown fast and into great magnitude. Much of it is of great value. Much of it, too, is unsatisfying, the prenomen typhoid being often used by writers to designate any and every form of slow fever of the asthenic type, and characterized by low, muttering delirium, tympanites and diarrhoea more or less pronounced. Hence the most contradictory views of this disease find utterance in the journals, and practitioners in the same communities are often found whose diagnosis of a prevailing continued fever is contradictory, much to the confusion of the laity and the discredit of our profession. Now, if we call a disease typhoid fever, let us be sure it is that specific type so named by Louis, or abandon his teaching on that subject altogether, and fall back upon the teachings of his predecessors, who described a variety of diseased phenomena under the title of typhus mitior and typhus gravior, wherein there was infection and blood poisoning, with its consequences variously expressed by symptoms and lesions.

Of all the various expressions of disease heretofore described under the two classes of typhus, the typhoid fever of Louis is the only one which seems to be specific, and characterized by a well defined eruption and certain lesions seated in the ileum. That there are many phases of inflammatory and malarial fevers, in which blood poisoning is a factor, adding to the gravity of cases, is not to be denied, but that they are not in every instance the specific infections of typhoid fever of Louis, must be borne in mind, in practice as well as in the reports of our clinical experience.

If we would arrive at a proper knowledge of diseases, especially fevers, of a low grade or type, we must be more careful of our diagnosis, and definite in our nomenclature. Without the former our own experience will prove of little value, and without the latter we cannot profit by the experience of others, or make our own to be understood by those who shall follow after us. If we would arrive at a correct knowledge of typhoid fever, we should confine the name to the disease described and so designated by Louis or discarded altogether.

Typhus (the historical typhus gravior) is a fever not specific (though often highly infectious) like the typhoid fever of Louis. In it there is a blood poisoning provoked in jails, in filthy hovels, and other localities by the putrid effluvia of decaying organic matter. Its infecting potentiality and gravity depend upon the character of the circulation of the atmosphere surrounding the patient, and upon the activity of the pro