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born Minnesotans, between the ages of fifteen and twenty-five, have died of phthisis, for us any longer to claim exemption from that disease.

Persons with Bronchial affections are not generally benefited by a residence here, the frequent recurrence of epidemic influenza seeming to aggravate the catarrh; yet it is frequently noticed that an attack of influenza does not appear to retard the recovery, or to seriously injure a case of phthisis. It is noticed, however, that among patients coming here with phthisis, chronic, nasal, and aural catarrh are very common, and that very many of them have rupture of the membrana tympani on one or both sides.

Asthma is not common in this region, and, as a general thing, asthmatics coming here from other parts of the country are greatly benefited. Cases of this kind usually demand a dry atmosphere, and when this climate fails to relieve them, we send them with much confidence to the still drier region of Colorado.

Epidemic Catarrh or Influenza is the most common disease of the Northwest. It prevails at all seasons of the year, but is most likely to appear in the late autumn and winter, and its influence modifies to some extent nearly every other disease. The U. S. A. Medical Reports from Fort Snelling, Minn., mention a severe epidemic of this disease as far back as 1839; and that the Indians about Minnesota were affected seriously by it. Since that time repeated mention has been made of it, and there can be no doubt that it has for many years affected the Indian tribes of this region. For this reason, if no other, we may conclude that the cause exists in the atmosphere, and not in our peculiar habits of life; our residence in close rooms heated by hot air stoves, or furnaces, etc.

For the last eight years it is certain epidemic catarrh has prevailed more or less every year; and while rarely very serious in its results, it has been a cause of great discomfort.

It begins usually with a decided fever and aching all over the body, very like rheumatism. The head aches violently, especially in the back part, and the throat soon becomes painful and stiff. The nose runs freely, and there is a tendency to perspire even while the pulse keeps frequent. The feeling of weakness and general distress is remarkable in all cases.

Thus established, the disease will continue from four to ten days, and passing off will leave the patient with nuralgic pains in the face and throat, or over the whole body; a feeling of aching or "being tired" in the throat often remaining for several weeks.

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The termination is, however, not always so favorable. cations arising are numerous. In some epidemics there will be a special tendency to acute tonsillitis; in others, to ulcerated sore throat; in others still, diphtheritic symptoms will appear most prominent. Toward the latter part of winter, prolonged attacks of influenza frequently result in bronchitis, pneumonia, pleurisy, or internal aural catarrh. Acute bronchitis, while not very frequent, is sometimes rapidly fatal. It is thought to occur oftener among children than with adults. Chronic bronchitis, as the sequel of an

attack of influenza, in quite common and is difficult to relieve. Pneumonia, which is here rarely developed as the direct result of exposure, frequently follows influenza. This form is generally manageable; it requires a supporting treatment, and will nearly always get well in about eight days.

When pneumonia does appear as the result of a sudden chilling of the body after being over-heated, it is not only severe, but frequently fatal. Many of these cases it is believed would be saved by a more free use of the lancet.

Pleurisy is rarely separated from pneumonia; and, as it is modified or not by the influence of influenza, so must generally be the decision as to its treatment; active, if it is idiopathic, but carefully supporting if the result of influenza.

Acute internal aural Catarrh is one of the most painful consequences of influenza, and during some epidemics it is not infrequent. Puncture of the membrana tympani has been necessary in some cases, and has been followed by immense relief.

As another consequence of this epidemic influenza, we have as a very common affection chronic nasal catarrh. This is no doubt aggravated by the sudden and extreme changes of temperature to which we are so often subjected in winter, by going in or out of our close, heated houses, but its foundation is generally laid by an attack of influenza.

Ophthalmia is quite common, generally of the catarrhal form, and disappearing under proper care in a few days, but where neglected, usually resulting in granular conjunctivitis. Purulent ophthalmia is not often severe; and cases where any serious injury to the eyes has resulted from snow blindness or from exposure to storms on the prairie are comparatively rare.

The Indians in this region are greatly troubled with chronic conjunctivitis and other affections of the eyes; the result, it is

generally thought, of their careless habits, exposure to smoke in their wigwams, etc.

Rheumatism in some form is, next to influenza, our most common ailment. It is peculiar in its attacks, being generally mild, and affecting in a subacute way nearly every tissue of the body. Few persons escape having, at some time or other, the muscular twinges or aching joints, or exceedingly sensitive skin, which so often indicates rheumatism; yet in the acute form, rheumatism is comparatively rare. We do not often have deposits in the joints, contractions of the limbs, or other deformities resulting from it; yet even from the mildest cases, we frequently get cardiac troubles. Especially is this the case with children. In them also we often find nephritic disease, albuminuria, etc., resulting from mild attacks of rheumatism. The disease is very often confined entirely to the muscles, or the fascia covering them, and not unfrequently it has resulted in suppuration.

Neuralgia comes next to rheumatism in point of frequency. It is often severe and persistent, and is not confined to any particular season of the year. It appears nearly as often in hot weather as in cold; while rheumatism is mainly confined to winter and spring.

Chorea, which is not uncommon here, and which is both severe and obstinate, has not been observed to follow acute rheumatism, yet it is very often accompanied or preceded by rheumatic or neuralgic pains.

Hysteria is also very common with the young who have suffered much from rheumatism or neuralgia; otherwise it is not often


Over a large portion of Minnesota and Northern Wisconsin, malarial fevers, i. e. intermittent and remittent, are unknown; but they do prevail to a limited extent along the banks of the Mississippi River, as far up as Lake Pepin; and after unusually hot dry weather, even to the Falls of St. Anthony. When occurring, the intermittent is usually of the quotidian form, and not very obstinate. The remittent is mild in form, and yields readily to quinine. Cases of congestive fever are more rare.

What we do most commonly see, in the latter part of summer and fall, in this region, is a continued fever of about three weeks' duration. This fever varies in type with different seasons, having at times decided remissions, violent head symptoms, bleeding at the nose, etc., and is called typho-malarial fever. At other times,

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the cases will have prominent enteric symptoms from the beginning, and they are called typhoid fever.

Typho-malarial fever in some years, as in 1871 and 1872, has prevailed as a wide-spread epidemic in the early fall, and has overshadowed all other diseases; yet when cold weather sets in, it has been merged into an epidemic of typhoid fever. An epidemic of this character prevailed extensively, last year, in the valley of the Red River of the North. That it is not an ordinary remittent fever, is proved by its being unchanged by the use of quinine; by its running a definite course, of about three weeks; and by its epidemic influence, being so frequently turned into typhoid. This fever requires little treatment, and its cases nearly always recover. . Typhoid fever is more or less prevalent every fall and winter, and local epidemics are frequently reported. It is more common, and more severe in the country than in the larger towns, and it causes a large percentage of the deaths reported every year. So many cases however recover, even when the enteric symptoms are violent, that we are justified in pronouncing it comparatively manageable. As many cases frequently occur in a family or neighborhood, and follow each other with painful precision, the belief naturally prevails, even among many of our physicians, that typhoid fever is contagious.

It seems certain, however, that this is not true. So many exposed young persons escape, who, by a subsequent attack of the disease, show themselves susceptible to the typhoid fever poison; and so rare is it, that any particular case is even suspected of bringing the disease into a neighborhood.

The disease is no more contagious than epidemic dysentery, or yellow fever; and, like them, its cause is in the atmosphere, a miasmatic poison, generated by local influences, of which we know little or nothing.

The treatment is mainly supporting, with enforced rest in bed, and warm applications over the abdomen.

Considering the comparative immunity of this region from malarial poison, the number of cases of hepatic disease is remarkable. In the late autumn, epidemics of jaundice, or of the peculiar morbid condition of that symptom, are not unusual; and it is quite a common thing to see organic disease of the liver. Jaundice occurring in pregnant women, is here frequently followed by premature labor and death.

Exanthematous diseases have with us no special significance.

They probably differ in no way from the same diseases elsewhere. As a rule, scarlet fever and measles are very mild; but occasionally an epidemic will appear of a very violent form, and many cases will result in death. Smallpox is often severe in form, but is rarely fatal.

The same may be said of erysipelas, which prevails to a considerable extent toward the latter part of nearly every winter.

About the same time of year, and apparently induced by the tendency to erysipelas, we occasionally see cases of puerperal peritonitis. It can scarcely be said, however, that this latter disease has ever prevailed here in an epidemic form. General peritonitis occurring in puerperal women is nearly always fatal. Pelvic peritonitis, which is not uncommon, generally ends in suppuration, the patient making a good recovery.

In non-pregnant women, uterine inflammations and displacements are quite common, but probably not more so than in other parts of the country. Cancer of the uterus is frequently seen, and considering the rarity of malignant disease in other parts of the body, it is all the more noticeable.

Diphtheria has been for twenty years an occasional visitor to this region; the different epidemics of it varying greatly in their character; at one time being very mild, and at others severe and rapidly fatal. It is most likely to appear in the fall and winter; is confined to no particular locality; or any peculiar class of people; yet most of the physicians seeing diphtheria, argue that it occurs most frequently among those who are not careful about cleanliness. It is decidedly contagious, the disease being carried from house to house by persons exposed.

The past fall and winter diphtheria has been confined mainly to the region about and above the Falls of St. Anthony; many fatal cases occurring at Minneapolis, Anoka, and St. Cloud, while at St. Paul and below, it has scarcely prevailed as an epidemic at all.

Under a mildly stimulating treatment, preceded if possible by the local application of nitrate of silver, either the solid stick or a strong solution, most patients with diphtheria will recover. Should the larynx, however, become invaded, the case is hopeless. The patient, it is true, may possibly recover, but no remedy now known is at all certain to aid in bringing about that result.

About the breaking up of winter, catarrhal or spasmodic croup is frequent among children, but yields readily to treatment.

Membranous croup, also, not unfrequently appears about the same time of year, and it is nearly always fatal. The treatment

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