I classify thus, for the reason that I find catarrhal manifestations in all cases, and that all the other so-called varieties are different types of catarrhal or the result of a toxic effect produced in the following way:

The essential substance necessary to the life and propagation of the bacillus of grippe is the hemoglobin of the red blood corpuscle, which is the active oxygen-bearing constituent of the blood.

The hemoglobin thus removed, the blood is deprived of this active property, and throughout the whole human economy we have deficient oxidation and consequent deficient elimination, and toxic effects produced therefrom.

The genito-urinary form mentioned by Guiteras was first observed by his finding such an excess of organic material in the urine of insurance applicants, during and immediately following an epidemic of grippe.

My own investigations confirm this observation, but I find it is due simply to the deficient oxidation and consequent excess of waste products.

This over-production soon clogs the excretory organs, and the kidneys, especially, not only fail to respond to the increase of work demanded of them, but owing to the clogging of these organs by organic matter their functions are greatly impaired.

The consequent toxemia results, and we have with the catarrhal grippe causes for the almost numberless manifestations of this disease.

Can there be a truer picture of a combination of catarrhal inflammation and toxemia than in the acute symptoms of grippe-weakness, nausea, anorexia, languor, inability to do any mental or physical work, rheumatic pains variously distributed, urine high colored, foul tongue and breath, fever, great nervous prostration, restlessness, wakefulness, sweating, etc.?

Among the first, if not the first symptoms of grippe, are

some of the catarrhal manifestations, watery discharge from the nose, feeling of congestion over bridge of nose and of the eyes, pharyngitis, tonsillitis, and occasionally bronchitis, with resultant cough.

If the catarrhal inflammation extends to the alimentary tract we often have in addition to the loss of appetite and nausea, frequent and violent vomiting, with a diarrhea tenesmic in character.

The inflammation may involve the bladder, and be accompanied with constant desire to pass water, as in one case I saw in an elderly lady, a complete retention of urine, necessitating the constant use of the catheter until convalescence.

I have already mentioned as symptoms of grippe the catarrhal complications of conjunctivitis, pharyngitis, tonsillitis, etc.; in addition to those, we may have otitis, epistaxis, hemoptysis, meningitis, glandular enlargement, dysentery and other common symptoms, due to catarrhal inflammation.

The muscular and articular pains of grippe I consider as purely rheumatic, unless complicated with neuralgia, and both symptoms due to the same cause, deficient excretion.

The rheumatism is a result of retained uric acid products with a possible serous exudation into the joints and the sheaths of the muscles themselves.

This statement will probably require further confirmation, but the results of investigations and treatment have so far justified it.

The neuralgias, as well as many other neuroses, together with cardiac depression and certain symptoms of the typhoid complications, are all due to the toxic effect of the retained waste products. The peculiar susceptibility of grippe patients to lobar and lobular pneumonia may be accounted for in the same way.

There is often in the latter stages of grippe, an crythema, sometimes papular, sometimes marginate.

In a recent case, I saw quite a number of purpurie patches, with permanent discoloration. The occurrence of grippe in connection with obstetric cases, intensifies the pains of childbirth and prolongs the puerperal period.

The lochial discharge is much more profuse and of longer duration. The diagnosis of grippe is usually simple. It could only be confounded with coryza, tonsillitis, bronchitis, scarlatina, or dengue.

The three first named would be excluded by the absence of severe headaches, prostration, loss of appetite, etc. Scarlatina is excluded on account of lack of punctate character of eruption and the strawberry tongue.

Dengue can often be excluded by its appearance only in malarial districts. The prognosis is in most cases good. The disease, however, is grave when it occurs in the old and infirm, or where the patient suffers from Bright's disease or valvular disease of the heart.

An epidemic of grippe is always a serious thing, as it seems to bring out latent disease, and aggravates the progress of those in course and terminates many fatally.

The treatment may be summed up in few words. I use only two forms, eliminative and supportive. I am so firmly convinced that most of the painful symptoms, complications and sequela are due to defective elimination, that it is almost a routine treatment with me to use a diuretic together with some one of the salicylates.

Salol alone acts charmingly. The salicylate of cinchonidia is a favorite of mine, as the supportive principle counteracts the depression of the salicylic acid.

For the nervousness I often combine with salicylate of soda the bromide of soda; and where the nervous manifestations are decided I always use some form of coca or kola, with strychnia.

Stimulants are to be used when indictated.

During the attack all patients must be confined to their beds, and in convalescence should expose themselves very cautiously.

I have not, in this paper, entered into the minute study of grippe, as my main purpose was to emphasize my beliefs in regard to variety and the causation of some of the more prominent symptoms and complications, and I feel assured that if this paper causes some physician addicted to the antipyretic or other form of treatment to renounce it in favor of the one here advocated, it will have done much good.

30 mt

THE GREAT PLAGUES OF HISTORY.

BY M. F. CARSON, M D., GRIFFIN, GA.

At first view, it may appear a matter for wonder, that there should be so wide-spread an interest in everything pertaining to the origin and dissemination of disease throughout the race.

Daily observation, however, reveals the fact that such interest is in reality well-nigh universal. Nothing, perhaps, so quickly engages the attention of the public as the account of some new disease, or the discovery of a new remedy vaunted as a panacea for human ailment, or the history of some great epidemic which has decimated-time and again—the populations of the nations of the past. We do not need to seek far, in order to discover the true causes of this anxious attitude of the public mind. It is at once obvious, that the universal law of death must ever lend a somber interest to all infirmities of the human organism; and hence it is, that all men, the wise and learned as well as the ignorant and narrow-minded, seize with avidity upon every shadow which gives the least promise of some delay in the inevitable termination of life.

The object of the present article is to recall the more striking features of the great pestilences of the past ages; to note the conditions of life under which they appeared; and, then, to refer to the success which has attended, and may yet attend, the efforts toward banishing such destructive maladies from society by an improved sanitation. It is of decided importance to understand what relation society sustains to the diminution of, not only the number, but also