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tration, etc., etc. A large per cent. of the cases were complicated with bronchitis and a few cases with scorbutic tendencies. In one case that I was called to see with the late Dr. J. W. F. Gerrish, hemorrhage from the gums occurred about the third day, which was followed by hemorrhage from the mouth, throat and kidneys, which it was impossible to control, and he died during the second week. Since writing this paper, I found a very able contribution in the April number of the American Journal of Medical Sciences, from J. Edward Squire, M. D., of London, in which the learned gentleman acknowledges that such a fever as typho-malarial does exist, but says the term is not so well defined as to bear a universal significance. In his quotation from Dr. E. G. Russell, who read a paper on malarial fevers before a London society in 1881, he says: "When a distinctly malarial complication accompanies and is bound up with the enteric fever, we have the disease that has been recognized and described by numerous writers in divers periods and lands as paludal-enteric or typho-malarial fever." His quotations from Sir Joseph Frayer, M. Leon Colin, InspectorGeneral Maclain and others, all of whom claim that typho-malarial fever is an old disease that has prevailed in all countries where malaria is found, and had been called by various names, as paludal-typhoid, paludal-enteric, miasmatic-typhoid, typhoidremittent, adynamic fever, etc., and there is good reason to believe that all these names and others have been applied to it. His criticism on the name typho-malarial is unjust when he says that the early use of any new medical term is necessarily somewhat indefinite, especially when those responsible for the name have not at first clearly indicated the condition which it is intended to signify; that to English practitioners, whose experience has been limited to their own country, the name is unfamiliar, and to all is wanting in accurate definition, and proposes the name of "malarial-enteric," in its place.

In conclusion I wish to say that I am satisfied with the name typho-malarial as the most appropriate for this form of fever until future generations shall have found one more expressive of this disease.

If I had the authority to offer a new name in place of all others

I would call it septic-remittent, believing as I do that it is a hybrid fever resulting from malaria and septic poison.

DISCUSSION.

Dr. Fields-Mr. President, some years ago I read a paper to this Society on the epidemic fevers of the West, in which I thought I disposed of that question beyond controversy, when it was referred to the Committee on Publication. It was not discussed, and to my astonishment it went by default. I say that the article is unanswerable. I showed that this thing called malaria is a mere matter of fancy; I hold that there is no such disease. There may be bad air in certain localities. I know we can make the air bad around us; but to say that the Almighty made this earth and surrounded it with atmosphere, and yet injected into it a poison to destroy the human race is preposterous. In cities, around factories,. you may have bad air, but when you go out into the open country into the open air and breathe it you will breathe pure air. I do not take for granted everything I see in the books; a man who has practiced medicine sixty years has seen enough to be authority for himself. I say that this thing of malaria is a matter purely of the imagination. One professor says that there is not a cubic inch of pure air over the globe, and that nearly all diseases come from bacteria in the air, and that quinine is the antidote. Now, gentlemen, I believe there are three grades of typhus fever. While I was in the army I took a great deal of care to investigate this subject. If men underwent lung hemorrhages and had poor diet they became enervated. Wherever you find men exposed to hardships and fatiguing employments, they are liable to have this grade of fever. But men who live west are not subject to it. It is not due to atmospheric moisture, but it depends upon our diet and habits. As I said, there are three grades of typhus fever, and what is called typho-malarial is the lowest. There are three forms of scarlet fever, three grades of small-pox-what we call varioloid is the very lightest; then we have the distinct or discrete form, and then the confluent, when it is very malignant. Now I have all due respect to gentlemen who differ from me upon this subject, but I must confess that I believe that fevers in summer are due to atmospheric vicissitudes. I have noticed it where I live, and have:

found invariably that where the weather changes suddenly you may look out for fevers. It is the change in the air and the action on the skin. I have known persons to go out in the morning after a cold, chilly frost, perfectly well, and come back at eleven o'clock with a chill upon them. The action of the cold air upon the skin is the secret of the whole thing. I do not believe in poisons in the atmosphere, because in that case it would take us all in. When yellow fever comes you will find that the thermometer varies forty degrees in twenty-four hours. I know very well that during the prevalence of yellow fever at Memphis I kept an account of the temperature and it varied greatly. Why did it disappear so suddenly after producing such ravages in 1878? Why, gentlemen, the fact is that when the atmosphere is of a uniform temperature you will have no sickness, only, may be, here and there an accidental case. Let the atmosphere change suddenly and you will see it will produce a very sudden effect upon the human constitution. Every man knows that the people consider the Ohio river water as the very healthiest kind of water, and yet it is the grand sewer for all the filth along the Ohio, down to its mouth; all manner of filth is drained into the Ohio, and yet that water is considered the healthiest in the world, though I do not regard that as being anything. You will find that where there are swamps and ponds there is a cold, chilly atmosphere which has its effect upon the skin, and you must keep the skin protected. I know I traveled in the swamps about Jeffersonville dressed warmly and came home all right when the atmosphere was so dense you could scarcely see, and kept myself well; if I had gone thinly clad I should have been sick.

Dr. Munford-Mr. President, during the epidemic that was in Jeffersonville one case was transported to my family. A relative of mine was treated in my own house. It was a fairly representative case I think of the cases that happened in the city, because she came from a city family where other cases had been. She had all the diarrhoeal phenomena. She had tenderness in the iliac regions, and had hemorrhage from the bowels. I don't know what to call such an attack as that except typhoid fever. Since then I have been prejudiced against the term of typho-malaria. With all due respect I suspect they miscalled it, and that it was a real

epidemic of typhoid fever. We can see how, if we considered it other than a septic disease, all precautions we could take, and that would otherwise be taken, would be overlooked. I think typhomalaria is a loose, and for obvious reasons, a dangerous term.

Dr. Woolen-Mr. President, I will say that three or four years ago-I don't remember just which-we had considerable of this so-called typho-malarial fever in this city. I was on duty as one of the attendant physicians at the city hospital at that time. At the opening of the season for clinical lectures we had six or seven of these cases on hand, and as fine illustrations as possible to find anywhere of the so-called typho-malarial fever. Only one or two had diarrhoea; some of them were constipated; two of them had adynamic symptoms. The fever ran up in the afternoon, cooling off the latter part of the night and morning. I called the attention of the class at the time to the fact that these cases, or one of them particularly, that I remember, did not even present the typical tenderness in the iliac region, and taking the other symptoms in connection, how much it was like the characteristic typho-malarial fever, and so little like the typhoid, no iliac tenderness, and no diarrhoea, etc. It was the misfortune of that patient to die, and the only one of the patients-apparently the most hopeful-was the one which died. We had the opportunity of making an autopsy. I never saw such marked appearances, such distinctly marked appearances, of typhoid ulceration of the small bowel, the ileum, and even extending through the ileo-coecal valve into the colon. We found in two or three cases, holding the bowel up, it seemed as if there was nothing intervening, the ulceration was so nearly through the bowel. Up to that time I had drifted considerably in the direction of typho-malarial fever, but those cases settled me.

Dr. Beard-Mr. President, I was not here when the paper was read, but I have views. It is a well known fact that Dr. Woodward of the army claimed that it was a distinct disease, but after his investigation he acknowledged that he was mistaken, and he found out his mistake just as Dr. Woolen found his. He was compelled to acknowledge before he died that he had been the cause of a great deal of trouble in the world in coining this term

of typho-malarial fever. My idea of it is, from the experience I have had, that it is simply a number of various diseases all classed under the name of typho-malarial fever, simply because it is a handy term and we don't know what it is. It furnishes a very good hole to get out of when we are required to make a diagnosis. There is a kind of malarial-fever that is simply a bilious fever that quinine does not arrest; it lingers for a length of time without any of the characteristics of typhoid fever or typho-malaria, but simply goes into a typhoid state. It is nothing in the world but malarial fever, perhaps complicated with some other disease. It is nothing more nor less than a malarial fever that quinine won't arrest. Why, on the Wabash, we have certain places that the bogs of the Nile can not beat for malaria. There are patients in those districts whom I am afraid to stick a knife into. Wounds don't heal up, but will slough away; they are subjects of chronic malaria. In the first place, when malarial symptoms are developed, you can arrest it with anti-periodics. Some five or six years ago it struck Vincennes in one ward, and only one ward. I was unfortunate enough to be health officer at that time. We found there was a very unhealthy locality; there were some old slaughter-houses with their filth around them; I had been working on them before, and these circumstances enabled me to remove them. We did not have it in any other locality. I call it simply typhoid fever complicated with malaria, just as it complicates everything else in a malarial district. At Nashville they had a peculiar kind; it was known throughout the army as "the new fever." It was carried by contagion throughout all the country. At the army headquarters they had congregated a large number of animals, and they had got the glanders; when they died they hauled them out to bury them, and soon they began to decompose, and the stench became terrible. This epidemic started, and they called it the "new fever," because they thought they had contracted it from these dead animals. My idea is that there is no such thing as typho-malarial fever, but that it is typhoid fever complicated with malaria.

Dr. McCaskey-Mr. President, I do not think that I can indorse the complete abolition of the term typho-malarial fever. I think in that disease we have a combination of types, a blending of poi

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