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world, and that it was called into life everywhere and at the same time by some meteorological condition.

Kern* makes a weighty observation against such a theory when he states that in an outbreak in the prison at Freiburg, the disease was confined distinctly to certain corridors.

Symptoms. We distinguish four types, viz. : the catarrhal, neuralgic, gastro-intestinal, and mixed. The attacks are sudden, without being preceded by a period of incubation. The patient complains of being chilly, there is fever, and sometimes vomiting.

In the catarrhal type we find coryza, pharyngitis, laryngitis, with intense redness of the fauces, bronchitis, and pain in the chest. The inflammation of these mucous membranes is undoubtedly due to the virus of influenza, but I have my doubts as to whether the lung complications, such as lobar and catarrhal pneumonia, stand as an effect to the same cause, or rather look upon them as the ordinary complication that may follow any of the acute infectious diseases.

In the catarrhal as well as the other forms we may have relapses, in which the symptoms usually become more alarming, and the temperature rises higher than in the primary attack. After the relapse the disease may be prolonged for a week or more, leaving the patient prostrated and without appetite.

In the neuralgic type the nervous symptoms predominate. There are severe cephalalgic pains in the lumbar region and joints, fever, and prostration. This has been the most frequent in my practice, amounting to sixty per cent. of my cases. In this, like the catarrhal form, we may have serious complications.

In the gastro-intestinal type we have marked prostration, fever, anorexia, heavily coated tongue, nausea, vomiting, epigastric pain and tenderness, and frequently diarrhea. This form is much rarer than the preceding ones. I have met with but four cases during the .present epidemic.

In the mixed type we may have part of all the symptoms described as belonging to the simple types.

* Aerzliche Mittheilungen aus Baden, Nov. 7th.

1

In all forms, whether catarrhal, neuralgic, gastro-intestinal, or mixed, convalescence in the majority of cases is slow, there is a persistent anorexia, and patients regain their strength very slowly.

Complications. Influenza, while in itself a benign disease, may give rise to complications which may prove very serious, and often fatal. This is particularly true with persons of feeble constitution, or those suffering from cardiac or pulmonary trouble, as the disease seeks out the locus minoris resistentia."

Sakolowsky* found malignancy characteristic of pneumonia complicating influenza, seven of his fourteen cases terminating fatally. In three cases death resulted from acute purulent meningitis.

Hispelbaum † speaks of ten cases seen at the clinic at Bonn in which mental disorder set in during convalescence. It was initiated by acute delirium, which in all cases but two passed into melancholia of varying duration.

Frankel-Hochwart | reports ten cases of neuralgia of the fifth nerve in association with influenza.

Laison s reports a case of gangrene of the leg in the course of influenza in an otherwise vigorous man of 37 years of age.

Mesnard || reports a case in which hemoptysis occurred, and Langraff*o reported having seen five cases of intestinal hemorrhage in connection with the disease, one of which terminated fatally.

In my own practice I have met with two case of pulmonary congestion, two cases of pleurisy, in one of which there was effusion, one case of lobar pneumonia, one of broncho-pneumonia, one of supra-orbital neuralgia, one of purulent otitis, one of gastralgia, and one case of hemorrhagic nephritis ; the latter case I saw in connection with Dr. E. M. Willett, all occurring in the course of influenza. It would be difficult to say whether the numerous complications of influenza are caused

* Internationale Klinische Rundschau, Nov. Toth.
† Zeitschrift fur Psychiatrie und Physiologie.
Butschrift fur Klische Medicine, Berlin.
2 Lyon Medical, Aug. 17th.
Journal de medicine de Bordeaux, May 11th.
° Berliner Klinische Wochenschrift, Mch. 24th.

by the same virus as the primary disease. We know that complications cease to be contagious. It may, however, be that the virus has become attenuated to such an extent as not to be able to reproduce the symptoms of influenza.

Etiology. Since the pandemic of 1889–90, bacteriologists have been making strenuous efforts to discover the cause of the disease, but bacteriological investigation has as yet not yielded any definite results.

Seifert, who was first to investigate the disease in 1889, found masses of micro-organisms in the nasal and bronchial secretions, consisting of streptococci pyogenes, diplococci, and some isolated cocci which he claims do not exist in the secretions of coryza rfor measles. Carnel claims that the microbes found in the nasal secretions in coryza and measles cannot be differentiated from those described by Seifert.

While I was assistant to Dr. Bremer, director of the bacteriological laboratory at the Missouri Medical College, I had occasion to make a number of cultures from nasal and bronchial secretions, as well as from lung tissue of patients who had died from pneumonia complicating influenza. Besides the streptococci and diplococci, we found a diplococcus resembling very much the diplococcus lanceolatus of Frankel. Mice inoculated with the secretions died in from twenty-four to thirtysix hours from septic infection.

Babes * describes new forms of bacteria obtained froin agaragar cultivations, and from cultures on nutrient gelatine and palates. These consist of extremely small constricted bacteria, sometimes forming short chains, sometimes fine rods, and sometimes rounded or pear-shaped. These bacteria readily produce lung affections. This form he named form 1. From cultivations derived from the secretions from the nose and frontal sinuses, he obtained form 2. This form differs from form 1 in that they are pointed with one convex and one straight side, and often provided with an unstained stripe. In mice and Guinea pigs they cause fatal pneumonia. He suggests that these forms may be a pathological element in influ

enza.

* Centralblatt fur Bacteriologie und Parasiteu Kund, Nov. 8th.

Treatment. It is necessary to say but little in relation to treatment. We know of no specific against influenza. The disease must be managed the same as we would treat the varied symptoms when due to other causes.

As soon as patients are attacked with the disease, they should be advised to wear warm clothing and not expose themselves to cold and dampness, and thus avoid relapses and complications which may prove very serious. If this advice is followed, relapses and complications will be rare in the majority of cases.

In the neuralgic type I have had excellent results from phenacetin and quinine, grs. v each, every three hours. This acts very promptly in relieving pain, reducing temperature, and producing diaphoresis. If the bowels have not moved, I add hydrarg. chlor. mit., gr. j, to each dose.

In the catarrhal type I have met with good results from mist. glycyrrhiza co., and a gargle of hot solution of acid boracic.

In the gastro-intestinal type, I have found bismuth subnitrate grs. x, acid carbolic gr. j, every three or four hours, to do good.

In the mixed type I have used a combined treatment, combating the most urgent symptoms.

In conclusion, I will give a summary of cases treated by me during the present epidemic: Total cases treated 52, of which 33 were males, 13 females, 6 children. Neuralgic type, 32 cases ; male 23, female 6, children 3. Catarrhal type, 15 cases ; male 8, female 3, children 4. Gastro-intestinal, 4 cases; male 1, female 3. Mixed, 2 cases ; male 1, female 1. Complications: Pulmonary congestion 2, broncho-pneumonia 1, pneumonia 1, purulent otitis 1, pleurisy (dry) 1, pleurisy (with effusion) 1, hemorrhagic nephritis 1, supra-orbital neuralgia 1, gastralgia 1; total, 10.

GLYCERIN IN BURNS.—The application of glycerin to a burn promptly relieves the pain, and favors the healing process. It at first produces a slight smarting, which soon passes off, and is succeeded by an almost entire freedom from pain. The sooner the application is made after the burn has been received, the more noticeable are the results.

THE TREATMENT OF GALL-STONES, WITH CASES.*

The treatment during the attacks consists in hypodermics of morphine and atropine, with the use of ether and chloroform, until the other remedies have had time to take effect. It is usually soothing to place the patient in a hot bath, and large draughts of hot water will relieve the distressing nausea. After gall-stones have formed, experience does not warrant us in placing confidence in medical treatment for their cure. The sweet oil draughts, as has been abundantly shown, only become saponified, and give rise to stone-like masses. Turpentine, chloroform and wild yam are not curative. Perhaps something may yet be found that, when injected into the bladder, will dissolve the stones. This is especially desirable for stones located in the ducts. It would seem that medical treatment would prevent their formation, but, so far, there is no very good evidence to show that any medicine has this effect.

A stone in the gall-bladder produces such a condition as to favor the formation of other stones, and after the operation for the removal of the stone and the relief of the local condition we have no return of the disease, except in a very small per cent, of cases. This is so in those cases in which stones had been forming rapidly before the operation, and would go

far to show the importance of the local causes of the disease. Then, in addition to general tonics, iron, phosphate of soda, mineral waters, etc., our dependence must be placed on operative procedures.

In some cases it may be difficult or even impossible to make a diagnosis of gall-stones, but it has been said very correctly that the mistake is much oftener made in calling gall-stones something else than in calling something else gall-stones. Paroxysms of epigastric pain, with tenderness over the lower hepatic region, accompanied with bile in the urine, and fol

* Abstract of a paper read at the fourth annual meeting of the Southern Surgical and Gynecological Association, by W. E. B. Davis, M.D., President of the Tri-State Medical Society of Alabama, Georgia and Tennessee; Secretary of the Southern Surgical and Gynecological Association ; Fellow of the American Association of Obstetricians and Gynecologists; Honorary Member of the Medical Society of the State of New York; Formerly Member of the Jefferson County (Birmingham) Board of Medical Examiners, and Surgeon to the Birmingham Hospital of United Charities, etc., Rome, Ga.

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