I believe the last case was one of sarcoma, and that it is cured.

With reference to general operative measures, I believe that a complete and radical operation is the thing to do, but I am unwilling to accept the view that such an extensive excision of the skin is necessary in all cases, as advised by Dr. Westmoreland. If my patient with sarcoma developing within the skin above the border of the breast has not sarcoma of the lung, I believe she is cured.

EPIDEMIC INFLUENZA, OR LA GRIPPE.
DIFFERENT PHASES AND NERVOUS

TENDENCIES.

ITS

BY W. O'DANIEL, M.D., BULLARDS, GA.

Influenza, uncomplicated, is known to be a self-limited specific disease, affecting the respiratory organs, and generally ushered in by rigors, and not infrequently by well marked chills, followed by fever and catarrhal symptoms. The terms influenza and la grippe are diagnostically considered synonymous, and indicating one and the same disease. No country in the world has escaped the ravages of this disease, so far as I know. The suddenness of attack, even of a whole continent almost at the same time, is not new, but wonderful and unaccounted for to the satisfaction of our progressive scientists. It has been supposed to be infectious, but its rapid spread over the whole country, nearly at the same time, rendered that theory highly improbable, and the causation by atmospheric and meteorologic changes more reasonable; but later on, scientific investigation has thrown new and progressive light by the discovery of the "germ theory," which enables us to consider more intelligently the development of the la grippe ptomaines, in whose presence we all stand, and may be infected by the bacillus of Pfeiffer, provided the conditions are favorable for development, and stay until destroyed by germicidal remedies, and, if not done, his dangerous inroads and ravages continue to prey, without physical resistance, until the deadly work is accomplished. Possibly we talk and write more from a theoretical standpoint about

the destruction of bacteria by germicides than we practically understand. Most physicians of to-day, who have been educated in their profession, are at least partially committed to what is known as the "germ theory," but ask them if they have an infallible specific or germicide or antidote. The answer will likely be, well, I cannot say that I have; but ask them if they have a specific or an antidote for malaria that can always be relied upon. The answer will be yes. Quinine is the infallible specific. This has been known by every practitioner of medicine ever since the dis covery and use of cinchona, and is now understood to a limited extent even by the laity. Supposing the "germ theory" to be correct (which I do not doubt), is it not pos sible, as well as practical, for us, when we find that we are in the midst of an epidemic of influenza, to make the conditions for the extensive development of germs unfavorable and thereby lessen the frequency of some of the dangerous sequelæ, by supporting, as best we can, patients depending upon us for protection against disease and death from the beginning or from the initial stage of the attack of influenza? If this can be successfully done, the constitutional powers of resistance are thereby increased by prophylaxis, as well as the ris medicatrix naturæ, thereby lessening the dependence on our own ability to combat the innumerable train of symptoms which we are likely to encounter during the course of the disease, by remedial agents, should it assume the neurotic and other phases, such as neuralgia, manifesting itself along the course of the sensory nerves and frontal sinuses (the orbital foramina being often the seat of paroxysmal pain). These pains, however, may be felt wherever there is a nerve, and the varieties of neuralgia are numerous. Impeded and disturbed locomotion, vertigo, middle-ear troubles, impaired vision of one or both eyes, quick consumption, even where there is no traceable heredity, pneumonia,

and especially the latent type, which is both insidious and deceptive, indigestion, impaired virility, general muscular soreness, rheumatism, nasal catarrh, headache, sore throat, and various supervening pathological changes and conditions, and not infrequently a general wasting, caused by some of these numerously mentioned complications. These different phases and neurotic tendencies are doubtless fruitful sources of insanity in some of its forms. The aftereffects of influenza are not always in proportion to the intensity of first attack, but often assumed, after convalescence, by relapses, which, in many instances, could be prevented by rest and prudence in a well ventilated room, with equable temperature, where sudden transitions of heat and cold should be strenuously avoided, in order, if possible, to secure immunity from these dangerous sequelæ, so that permanent and speedy recovery from first attack may ensue. dence, hygiene and alimentation always play an important part in the successful preventive treatment of la grippe sequels, and is an important factor in reducing the deathrate.

Pru

Relapses and slow and imperfect recoveries are not so common in milder climates, where weather changes are infrequent. Many patients succumb to the after effects of influenza from sheer neglect, because their sufferings are not sufficiently distressing at first to admonish them that danger is apparent and the advice of a physician is necessary. I have recently known a mother of fifty and daughter of twelve years to die of quick consumption, where there was no hereditary predisposition, without seeking medical advice until absolutely too late, because they and their friends persistently contended that they had only a bad cold.

a

When influenza proper is not followed by some one of the long train of complications, the usual course is about one week, then convalescence and recovery.

In recent years, say since 1889, its annual visitations have been expected in the United States, and we have not often been disappointed, although the phases and tendencies have somewhat differed; so much so, I think, as to make differential diagnosis necessary to discriminate between the different forms of the sequel, now so common. There are certainly distinctive features in the sequelæ sufficient to require altogether different lines of treatment to meet the various indications.

After all, we are compelled to treat symptoms as they develop and not the names influenza or la grippe. It is pretty well established that the after effect of influenza is more to be dreaded than the primary attack, for it is more lasting and more dangerous to human health and life. This fact is almost daily demonstrated by those who have suffered from la grippe, and who have had imperfect recoveries, to date the commencement of any subsequent physical disability to the time when they had "grippe," more especially people well advanced in age and with whom fatalities are much greater than younger people.

That diseases do assume different phases, tendencies and types, I presume will not be denied. A very clear illus tration of this fact, to my mind, is had in malarial hemorrhagic fever, which is only a different form of pernicious bilious fever, known to follow intermittent and remittent types in districts where there is a superabundance of malaria. It is certainly of malarial origin. I never saw a case of malarial hemorrhagic fever that had not been preceded by the toxic influences of malaria. This hemorrhagic phase, in a malignant form, only appeared in localities favorable to malarial fevers as late as 1868, and continued its annual visitations (generally in autumn months) for about fifteen years, at the end of which time its malignancy began to lessen, and now this hemorrhagic condition, which was at one time almost a symptom of dissolution, is exceedingly rare; only now and then a spasmodic case is