body. But would these causes so combine if there were no firm cranium to respond to their call, and so increase irritability of the uterus by its hard and unresilient pressure upon its wall as to whip it into active and permanent contractions? My case would seem to answer, "No."

Furthermore, I find, on investigation, that as a rule these acranial monsters are of unusual size, and are spoken of as bodies of fine development. Is it not possible that, as a rule, these monsters, like this specimen, were over term, and attained their malignant growth by extended life in utero?

LA GRIPPE.

By W. C. LYLE, M.I., AUGUSTA, GA.

I realize that my paper would have been much moreopportune could it have been presented some months ago, for at that time there seemed to be a general epidemic of this dread disease, of unusual severity and embracing almost every variety of symptoms.

However, I hope that this paper will at least evoke some interesting discussion relative to a disease which, in many respects, is still a somewhat mysterious one.

During the epidemic of 1890, when grippe attracted such universal attention in Europe, it was at first supposed to be some new disease, a product of our modern civilization, and it was so accepted and treated not only by the public and by the newspaper press; but by a small portion of the educated physicians.

When the epidemic shortly afterwards crossed to this continent, and attacked us in all its fury, it was regarded by many of the medical profession and almost all the laity as only a more fashionable name for a “bad cold.”

Further research and more extended investigation, how-ever, revealed the fact that this was merely the reappearance of a disease familiar to the world for ages, but which in its epidemic form has been so long dormant or absent from the western world, that its very existence had been forgotten, or it was looked upon as an extinct disease.

It may be of interest to introduce at this point a résumé of what students of medical history have resurrected from the past relative to the antiquity of grippe.

Those who have delved into the history of epidemics and epidemiology, recognize in grippe merely a recurrence of a disease which for centuries has periodically ravaged the whole civilized world.

These epidemics date from before the Christian Era, an attack having occurred in the Athenian army in Sicily 415 B. C.

After this they began to appear at irregular intervals, spreading over Europe generally in the direction of from east to west, of which no exact or complete records have been kept up to the year 1510, when it prevailed in the British Isles to quite an alarming extent, and quite an accurate account of the epidemic was written.

Hippocrates himself gives an account of an epidemic which ravaged Northern Greece in the fifth century before our era, a description of which he summed up as follows: "It was an infection frequently, in fact most often, ushered in by a kind of cough, intermittent at first, but recurring and accompanied in its recurrence by visual disturbances, sometimes with anginas and occasionally with paralysis of the limbs. Sometimes it followed a pre-existing fever, producing feebleness, pains, even abscesses of the limbs, etc.

Thus it will be seen that grippe possesses a very respectable antiquity. When we seek for predisposing influences there seem to be few.

People are attacked without regard to age, sex, occupation or social standing; the young and the old, the rich and the poor, male and female, the king upon his throne and beggar in his hovel.

Overcrowded, unhealthy, ill ventilated and damp dwellings render attacks more severe, but the dwellers are no more subject to them.

Previous or present illness is no protection and one attack renders no immunity to another.

Perhaps I should mention here, that according to ob

servations made by Goldschmidt, of Madeira, in the presence of both diseases as epidemies, revaccination with vaccine virus protects not only against variola, but also against grippe.

This statement though, needs more complete verification. There seems, however, to be a predisposing influence in overwork, anxiety or care, and according to Dunglison in outbreaks of the disease in hospitals, the physicians and nurses were the first to be attacked.

In the South, at least, the seasons may be regarded as influencing the disease, for we seldom see a case or hear of an epidemic during the hot months, but relative altitude above the sea level seems not to influence it at all.

The

In one respect the etiology of the disease is settled beyond question, since the discovery by Pfeiffer, of Berlin, in 1892, of the bacillus of grippe, which, owing to the singular fact that only the ends of the bacillus stain, had before been mistaken for diplococci or streptococci. origin of the bacillus, however, is by no means settled. Many authorities believe the cause to be in the air, and with good reason, as the crews of ships are attacked after they have been some weeks out, and with no communication from land.

Hermits are said to have been attacked in the woods or in the caves of their isolated homes. But evidence is accumulating to indicate that the disease is contagio-infectious rather than miasmatic-infectious, the bacillus coming from another person having the same disease.

The fact that it travels only as fast as people travel, and that it does this contrary to the direction of prevailing winds, are strong points in favor of this opinion.

The opposing fact that inoculations have thus far been unsuccessful in transmitting the disease is, however, against its contagious nature. It is difficult to fix the place

amongst the acute infections where grippe really belongs; whether it shall be considered a miasmatic or a contagious. disease will depend altogether upon what is meant by these

terms.

Advocates of miasm contend that the disease originates. of itself in different places or that it is carried by the wind, and meet the objection that it is often carried against the wind, by the assumption that the currents at greater altitudes move in different directions.

It cannot be denied, however, that grippe shows itself first along the lines of river and rail, and that it appears first in towns about railroad stations, later in places more removed from the lines of travel.

There is no disease in which the characteristic symptoms vary as much in the various epidemics as they do in grippe, and there is also no other in which the symptoms vary so much in point of predilection and severity.

The predilection depends upon individual weakness and the susceptibility to disease of certain systems, as the nervous, respiratory, alimentary, and as Guiteras first mentions in a paper read before the Pan-American Medical Congress in 1893, relative to observations made while investigating the disease for the Health Department of the city of New York, and from which I quote freely, the genito-urinary.

The varieties of the attack during the different epidemics: have given rise to numerous classifications, depending upon the different seats of the disturbance, such as cephalic, thoracic, abdominal, cerebral, bronchial, and typhoid.

The classification preferred at the present day seems to be that of the nervous, catharrhal, and gastric.

From personal observations I am inclined to the belief that there is only one type of grippe-catarrhal; and that all other varieties, such as gastric, musculo-neuralgic, respiratory, alimentary, etc., may be classified as either complications or sequelæ.