Lasts 3 or 4 weeks, Can be interrupted can not be inter- and cured in a few rupted. days. Nervous Implications. In discussing this subject, I am fully aware that a large and influential number of our profession doubt and even deny the correctness of the term Typho-Malarial Fever, but I am a de- Great nervous discided advocate and follower of Wood-turbance and prostraward, Flint, Hume, Hirsch, Griesinger throbbing, persistent tion; dull, heavy, and many others, that the nomenclature frontal headache; is correct and better suits the disease or twitching of muscles, dual disease in question than any other tickling of the throat, yet used. F. de Habilland Hall, of deafness, mind stupid. ringing in the ears, London in his work on Differential Diagnosis, says "The experience of numerous observers has proven that there is a complex form of fever prevalent in malarious districts in which the typhoid and miasmatic elements are combined." It has been proposed by Dr. J. J. Woodward to call this typho Asthenic, not wild. Frequent. None. Delirium. Sthenic. Epistaxis. None. Lungs. Diffused bronchitis, Congested when af malarial fever a term which he explains with tough, tenacious fected at all. to be applied not to a specific or distinct sputa. type of disease, but the compound forms Pulse. More frequently high, full, and bounding. Skin. of fever which results from the com- From 70 to 140 beats *Read before the Harford County Medical Society August 9th, 1887. Hot, even when Dry and hot, odor moist, emits a peculiar acid and swampy. musty odor, pathognomonic of this fever.. crease of temperature from morning to evening of about two deg., and a decrease of one deg., from night to morning, commences first day 98.05 deg., reaches its maximum ⚫ of 104 deg. on the morning of the fourth day;from this time the evening temperature rises from 103 to 104 deg., morning one deg. lower. duration, number, extent and place, that they need never be mistaken for the deg., or more first day of pins head, appear Tongue. Protudes tremblingly, is covered with a whitish yellow coat, which disappears and is replaced by a dry pale, brown one, with red glazed tip and edges; teeth covered with dark brown sordes. Coated all over with a heavy dark yellow coat, no sordes. curs. Mortality. Great, average one Very slight, not one in five. fatal case in 100. Lesions. Inflammation or ulceration of Peyer's solitary and Brunner's glands; perforation of Sallow, eyes yellow. bowels, with peritonitis and fatal hemorrhage, inflammation and enlargemeat of Complexion. Foaming, light Dark color, turbid, mesentery glands, color, free from sedi- no albumen. ment, frequently con tains albumen, has typhoid odor like body. Excretions from Bowels. Diarrhoea except in Bowels costive, and the spleen, which Hemorrhage from congestion of bowels rare, congestion of stomach, lungs, liver and spleen; the two latter enlarged. Then he goes on to say, "We shall mildest cases, stools dark, hard, dry, bil now consider the characters of a disease offensive, pea soup, ious stools. bright yellow or presenting in its different stages symptoms both of malarial and typhoid fever. The name Remittent Typhus was given it by Dr. D. Drake, who also spoke of it as 'the typhoid stage of remittent or autumnal fever.' He does not consider No tympanitis or it a distinct disease, but a genuine giving the shape to ab- tenderness of abdo- hybrid of typhoid and remittent fever. brown, devoid of South. intermittent. Constipation the rule. Tympanitis rare. TYPHO-MALARIAL. from bowels, generally oft repeated Typho-malarial only and my patient dies in from two to four in miasmatic localities weeks, generally at the end of the second most commonly in the from hemorrhage from the bowels, with Often begins as a all defined symptoms of typhoid, but simple remittent or beginning as an ordinary case of intermittent. My inference is that two distinct poisons may exist at the same time in the same body-it is questionable; the greatest will make the greatest manifesAbdominal tender- tation. If the marsh effluvia predominess slight, epigastric nates we have its effects fully portrayed; and hepatic tender--if vegetable and animal poison combined predominates we have typhoid, put the two together, and we have the dual result, typhoid and malarial fever, and no typhoid condition of two specific spleen very marked. poisons ever exist in the same subject. Typhoid condition as I understand it means low-low is an entity in medicine as in other things. The typhoid poison is a distinct product of all bad causes, with specific manifestations-animal, vegetable, atmospheric and paluvial, or any of these combined. Malarial poison ness considerable. Temperature high, especially on outset, delirium active. Tumefaction of Sordes rare. Rarely involved. Generally entirely absent. Pigment deposits in various tissues and THE Selected Articles. MALADIES OF OLD In Libert in Ziemssen's Cyclopedia of is entirely vegetable and paluvial, genthe practice of medicine well describes erated by heat and moisture. the disease under the title of Bilous malarial or low swampy districts we Typhoid or Relapsing Fever, and goes have exceptionally typhoid-generally on to state Griesinger's descriptions, the malarial poison and type, the two which are elaborated from his rich Cairo are sometimes combined, which seems material,and may be rightly regarded as to me is most properly termed typhoopening the way for the reception of malarial fever. bilious typhoid into pathology. A few months ago a self righteous and a selfmade physician from the State of Texas wrote to the Medical and Surgical Reporter of Philadelphia, or The World, an ipsedixit article proclaiming that the physician who speaks of typhomalarial fever, has either never his seen case in time, or badly treated a case of intermittent or remittent fever. Why? Ans. I called to see a case, supposing it the analyses derived from the accounts The following remarks are based upon an ordinary one of intermittent fever of 824 persons, which were given, with and began to treat it as hundreds be- few exceptions, by medical men, and fore, running the ordinary course, with which were in reply to the inquiries of, ordinary remedies, and in from four to and upon the forms issued by, the Colsix days my case, chills and intermis- lective Investigating Committee of this sions ceased, and it lapsed into a con- Association. Of these 824 persons, there tinued fever with rising evening and were 340 males and 282 females between falling morning temperature, tongue 80 and 90, and 92 males and 110 at first yellow coated, then dry brown, females between 90 and 100. cracked; abdomen tympanitic, right gurgling, ileac tenderness, hemorrhages BY PROFESSOR HUMPHRY, M.D., F.R.S. Professor of Surgery in the University of Cambridge. *From British Medical Journal, July 16th, 1887. I may first observe that, with regard It will probably accord with the exto Diseases and Failures of Particular perience of those present that some Organs, the immunities were in favor combination of sedative with stimulant of the women, amounting to 55 per cent. medicines affords more relief in these in the case of the men. The affections cases than any other treatment. of the urinary organs especially preponderate, as we might expect, in the men. They are, indeed, more than twice as frequent in the men as in the women, amounting to 42 per cent., whereas in the women they were only 20 per cent. In the women, brain affections are more frequent than in the men, being 16 per cent. to 7 per cent. But the failures in the heart and in the lungs are about equal in the two sexes. It is worthy of note that 85 per cent. of the whole number are reported to be free from any evidence of rheumatic affections of the hands. With regard to the Heart we do not get much evidence of disease. Some irregularity or intermission of pulse was noted in about a fifth of the cases observed. In a few there were stethoscopic indications of valvular disease without any other symptoms. Whether the oedema of the legs observed in certain cases, and which we are familiar with as an occasional temporary affection in old people, is attributable to an imperfection in the heart, or to some other cause, I do not know. A knotty condition of the arteries, indicative probably of calcareous degeneration is reported in 12 per cent. Of the various maladies, Bronchitis is the dominating one, and, super- The Brain affections, and the readded to debility, it is oftener than any coveries from them in old people, are other assigned as the cause of death. It among the most remarkable of their is, indeed, including the common winter maladies. We are all familiar with the cough, a very frequent malady in this fact that passing attacks of unconsciousclimate at all times of life. In the ness, whether they depend upon tempoaged it is liable to become persistent; rary congestion, or mere suspension of and a slight increase coming upon the cerebral activity, or other causes, are by enfeebled circulation and general weak- no means uncommon, and leave often no ness of the old person often produces a permanent diminution of mental power. fatal result. The demands on the The impairment or loss of motor power activity of the respiratory functions are, in some part, as a limb, is, of course, a it is true, diminishing in the aged in serious addition, forasmuch as it comproportion to the diminished activity of monly indicates a lesion or decided failthe nutritive and other processes; but ure in some locality of the brain, probthe respiratory capacity, which depends ably of the same nature as we find in much upon the elasticity of the thoracic similar attacks in less advanced age; walls and of the pulmonary tissue, is and a paralytic seizure not infrequently liable to diminish in still greater ratio. ends the long but not necessarily strange Hence the expiratory movements, which or eventful history. But we are surare in great measure the resultants of prised to find how even these attacks in elasticity, are performed incompletely the aged are not infrequently more or and with effort, and the expulsion of less recovered from. Thus there are 25 mucus from the air-passages is effected cases in which brain-attacks associated with difficulty. Thus a continual source with paralysis, in most instances hemiof irritation is provided, which, on plegia, and in some some with convulslight provocation, extends into the sions and unconsciousness, were in greatsmaller bronchial tubes, and is reluctant er or less degree recovered from. In to quit its hold there. In a few cases some the recovery was complete. One the affection was habitual and had been man had three attacks of paralysis, at so for years. In some there had been 82, 85, and 86; and one woman, in addirecurrence of attacks of considerable tion to several attacks of unconsciousness, severity, with complete recovery, at a had left hemiplegia and convulsions at 78 very advanced time of life. paralysis of the left hand at 82, and severe these being between 80 and 90. apoplexy at 89, after which she was able them being more on the alert, 5 of the to get about again, though with weak-men and 6 of the women had gout, all ened mind and liability to epilepsy. While considering this point we do not Two cases of Senile Gangrene were forget that in the aged person the brain noted. They were in men above 90. is gradually and progressively shrinking, The severe forms of Malignant Disand the interspace between it and the ease are rare. One man, above 80, had skull caused by this shrinkage is being rapidly advancing sarcoma of the filled by fluid effusion in the subarachnoid shoulder; 5 women, between 80 and 90, or pia mater tissue; and there may be had cancer of the breast; 5 men and 1 temporary irregularities and imperfec- women, had epithelioma; and 1 man tions in this compensating adjustment and 1 woman had rodent ulcer. None of pressure of fluid on the surface and of these maladies are mentioned in the of the blood circulating in the interior, men or women above 90. Still, although which would to some extent account for the very aged appear to be less liable to these cerebral attacks, and also for the some of the more severe diseases, such recoveries from them. The senile altera- as cancers and diseases of the urinary tions in the arterial coats must also be organs, they are, on the whole, rather an important item; but our knowledge more liable to the ordinary maladies, of the physiology of the cerebral circu- the proportion of those above 90 who lation is at present scarcely sufficient to were altogether exempt from malady enable us to make clear deductions re- being 34 per cent., while those between specting its pathology. 80 and 90 was 43 per cent. In only 11 out of the 340 returns of With regard to the Eye, 8 per cent. men between 80 and 90, and in only 1 are stated to suffer from cataract, 80 per of the 92 returns between 90 and 100, is cent. are said to have good sight, alProstatic Disease said to have existed; though 83 per cent. use glasses. Some in one of these it had existed several have used glasses for many years, which years, and in others two, three, and four is confirmitory of what I said in the acyears respectively. In one the affection count of the centenarians, that "the ocis said to have given less trouble than currence of presbyopia does not seem to formerly. The condition of retention be associated with, or to be a prelude relieved by frequent use of the catheter to, inconvenience or impairment of may be extended with care over many sight beyond that which may be correctyears; but the enlargement of the pros-ed by glasses. tate, with its associated bladder-symp- The more frequent failure of the ortoms, is, I fear, a malady from which re- gan of Hearing, which is noted in more covery, even in old age, is scarcely to than one-half (56 per cent.) of the rebe expected. It is something to find turns, is probably due in great measure that our reports confirm the view that it to the liability to impairment of the is a malady from which age gives, after delicate mechanism of the middle ear— 70, a gradually increasing exemption. the tympanum with its membrana tymFifty-two were troubled with Rheuma-pani, its ossicles with their joints, its tism in some of its many forms, which muscles, its Eustachian tube, and its lininclude pains in the limbs, aching in the ing membrane-in consequence of colds, bones, etc., for which, I suppose, a shocks, and a variety of causes. But in remedy is not very easily to be found. comparing the organ of hearing with Indeed, it is difficult to define precisely, that of sight, in this respect, we must or clearly account for, the various pains, not forget that the lessening of elasticity rheumatic and other, which old people and muscular activity-which we must complain of, and which disturb their assume to induce defects in hearing in comfort without materially affecting old persons corresponding with the their health. The women suffer from visual defects classed under the term these even more than the men, probably presbyopia-does not, like the latter, adconsequence of the nervous system inmit of alleviation by an early applied in |