ease.

gives a distinct name to the inflammation with which it may be affected. Hence we have coryza, angina, laryngitis, and bronchitis. But it often happens that, in the same attack, all these parts are successively or simultaneously the seat of inflammation, which, therefore, may be said to constitute one disFor this, in its full extent, we have no other name than catarrh. Some writers consider catarrhal inflammations as peculiar or specific, "characterized by slightly increased vascularity, afflux of the circulating fluids, and augmented secretion." I have never been able to discover anything specific in its character. The inflammation, which begins with increased secretion in the nostrils, very often becomes dry when it reaches the throat or bronchial tubes; and yet it can hardly have changed its nature. There is a certain grade or stage of inflammation in the mucous membranes, in which they are disposed to copious serous or thin mucous secretion; and what these writers designate as catarrh differs from other examples of inflammation only in this respect.

The disease usually begins in the nostrils with coryza, then invades successively the fauces, larynx, trachea, and bronchia, and finally loses itself in the ramifications of the last mentioned tubes. Sometimes, especially in children, it penetrates to the vesicular structure of the lungs, and constitutes pneumonia. Not unfrequently, also, the inflammation commences in the fauces or larynx, and runs downwards; and, in some instances, making its first appearance in the bronchial tubes, it extends upwards as far as the nostrils, giving rise to coryza.

The grade of inflammation is apt to be nearly the same throughout this course, unless modified by treatment. If the coryza or angina be light, the chances are that the bronchitis will be light also; and vice versa. Some of the worst cases of bronchitis begin as intense inflammation of the fauces, extending to the submucous tissue. When the disease reaches the chest, and is attended with febrile symptoms, it is called catarrh fever.

It is unnecessary to treat of the symptoms of catarrh. They vary with the part or parts affected, and have been sufficiently described under the preceding heads. When severe, the complaint is almost always attended with fever, and, even though slight, is not unfrequently thus attended, if it occupy simultaneously a great extent of the respiratory passages.

The treatment has been already fully detailed. Thus, when the disease occupies the nostrils, it must be treated as coryza; when the fauces, as angina; when the larynx, as laryngitis; and, finally, when the bronchia, as bronchitis. It is only necessary to state here, that it is often highly important to arrest the disease, or diminish its violence, in its earliest seat, so that it may either not reach the bronchia at all, or reach them in a milder form. Hence the propriety of attacking inflammation of the nostrils and fauces more efficiently than if the complaint were to be confined within these limits. Attention to this suggestion may often prevent a long continued, if not serious attack of pectoral disease.

In the cases of individuals subject to frequent and severe attacks of catarrh, it is sometimes very desirable to meet the disease upon the threshold, and turn it aside if possible. This is true in whatever portion of the air-passages it may make its first appearance. The means calculated for this purpose are, chiefly, a large dose of opium at bedtime, and the production of a copious and continued flow of perspiration. For the modes of carrying these measures into effect, and the cautions necessary, the reader is referred to the article on coryza.

4. INFLUENZA.

Syn.-Epidemic Catarrh.-Grippe (Fr.).

The name influenza, adopted from the Italian, has been applied exclusively, though with no great propriety, to an epidemic disease which usually takes on the character of catarrh. The first epidemic of this kind, of which we have any distinct medical record, occurred in the year 1510. There can be little doubt, however, that it has occasionally visited mankind from the earliest ages. Since the year mentioned, we have numerous records of its occurrence, at irregular intervals, down to our own times.

The epidemic appears to have been altogether irregular in the period of its recurrence. Sometimes returning in two or three years after its disappearance, it has, in other instances, postponed its return for seven, ten, or even twenty years. Nor does it appear to have observed any certain course in its progress. In general, however, its tendency is to proceed from the East. towards the West, and it probably marches more frequently from the south northward, than in the contrary direction. On the old continent, it has sometimes commenced in Russia, advanced westward through Poland and Germany, then crossed into Britain, and afterwards visited successively France, Spain, and Italy. On other occasions, it has begun in the southeast, and entering France and Spain from Italy, has thence proceeded to England, and swept round the north of Europe. In this country, it has sometimes proceeded from the northern states towards the southern; on other occasions, has commenced in the latter, and marched towards the north. Its spread is usually so rapid, that it not unfrequently appears throughout vast extents of territory almost simultaneously. Oceans seem to oppose no obstacle to its course. It has leaped over from Europe to North America, has been observed in solitary islands in the midst of the ocean, and has attacked the crews of ships far out of reach of any communication from the land. It appears sometimes to have made the circuit of the whole globe. There is a considerable resemblance in its course to that of epidemic cholera, the march of which it has both immediately preceded and followed.

At the moment of invasion, it seizes almost simultaneously on great numbers, and before its departure sometimes involves almost the whole population. Its average duration, in each neighbourhood, is about six weeks; though the cause appears to linger after all the susceptible material for its action has been exhausted; for strangers arriving in the affected region, after the disease has apparently ceased, are not unfrequently attacked. The inferior animals appear to suffer as well as man. Many instances are on record, in which horses, dogs, sheep, and even birds have been seized by the epidemic. Some persons are much less susceptible to the morbid influence than others, and some appear to be altogether insusceptible. No obvious cause exists for this discrepancy. All ages, both sexes, and every variety of temperament and occupation, are equally liable to attack. It has been estimated that from one half to three quarters of the whole community are in a greater or less degree affected.

The disease exhibits, on the whole, a remarkable uniformity of character, though it has occasionally differed much in its grade of severity, in different times and places. In general it is very mild; but, on some occasions, and in certain localities, it has proved extremely fatal. Thus, during the epidemic of 1850, nine thousand persons are said to have died of the disease in Rome. It is probable that other epidemic influences may occasionally combine with and modify it in certain situations. It may, for example, be con

ceived that, if it should appear in a neighbourhood already tainted with a typhoid influence, this might fearfully increase the mortality.

In many of the epidemics, authors have recorded unusual changes in the temperature, moisture, and weight of the atmosphere; but the same state of the weather has not been observed in different places attacked; and not unfrequently there has been nothing uncommon noticed. It appears that the disease has prevailed in all climates, at all seasons, and in every possible thermometrical, hygrometrical, and barometrical variation. It has sometimes occurred in summer, though more frequently in the colder seasons.

Symptoms.-Influenza usually appears with the ordinary symptoms of catarrh, upon the whole, in a rather aggravated form. In many instances, however, it is very light, without fever, and scarcely regarded by the patient. It usually begins with coryza or sore-throat, and the common preliminary symptoms of fever, as feelings of lassitude and weariness, pains in the limbs, chilliness, rigors, &c., which are followed first by heat of skin, headache, and excited pulse, and soon afterwards by cough, uneasiness in the chest, and other signs of pectoral disease. But the symptoms of nervous derangement are in general much more prominent than in ordinary catarrh, and there is greater muscular debility. Disorders of sight and hearing, giddiness, pains in the back and limbs, general uneasiness, and depression of spirits are not uncommon in this disease. The headache is often severe, sometimes affecting equally the whole head, but more frequently concentrated in the forehead, and especially in the region of the frontal sinuses. Not unfrequently the pains extend to the back of the neck, in the form of rheumatism, and to the cheeks and temples, which are very sore and painful. Disorders of stomach, such as nausea and vomiting, are more common than in ordinary catarrh. But the most distinguishing feature of the disease is the debility which attends it. Almost all writers are agreed upon this point. In some of the epidemic attacks, it seems to have been less striking than in others, and in a few instances the pulse is said to have been strong, and to have not only borne, but imperiously demanded depletion. But, in the much greater number of instances, it is described as having been feeble; and in some, the debility was extraordinary, so that the disease would not at all bear the loss of blood, and death was in numerous cases ascribed to bleeding. So great was the prostration of strength, that the patient fainted merely upon attempting to sit up. Another striking circumstance is, that the debility often continued for a considerable time after the cessation of all other symptoms. I cannot say that I have observed this extraordinary debility in the epidemics which it has been my lot to witness; but the testimony to the fact is too strong and united to admit of denial. Ás in ordinary catarrhal fever, there is generally a remission of the febrile symptoms in the morning, and an exacerbation towards night. The degree of intensity in the nasal, throat, and pectoral symptoms is extremely variable. Sometimes the affection of the mucous membrane scarcely exceeds the point of irritation or congestion; and, even when the cough is considerable, auscultation does not always detect the signs of bronchial inflammation.

But the effects of this epidemic influence do not necessarily appear in the shape of catarrh. In some instances, its force has been spent upon the brain; and violent headache, flushed face, delirium, and fever have been the promi nent symptoms. Sometimes the digestive organs have been affected, and the sease has been evinced chiefly by epigastric pain and tenderness, nausea, iting, &c. Occasionally it has appeared in the form of colic, diarrhoea, ysentery, which have either existed alone, or as complications of the hal affection, especially towards its close. Inflammations of the lungs,

pleura, and pericardium have always been frequent during the prevalence of influenza, and have undoubtedly been dependent upon the same cause as that of the respiratory passages. Sometimes inflammation has appeared in these situations as an original affection, and sometimes as an attendant upon the bronchial disease. Abscesses of the frontal sinuses were noticed by Rush among the forms of influenza. Hæmoptysis not unfrequently occurs in persons predisposed to it. Authors speak also of inflammation of the urinary organs among the effects of the epidemic cause.

Epidemic catarrh has usually the same course and duration as the disease from ordinary causes. It generally terminates favourably by perspiration, copious mucous secretion from the bronchia, or increased discharge of urine, which deposits a sediment on standing. Pustular eruptions, erysipelas, and scarlet rashes, are enumerated among the phenomena which occasionally occur at the close of the complaint. The duration of the disease varies from two or three days to one or two weeks; and a cough is frequently left after the other symptoms have disappeared. The fever probably, in most cases, goes off about the fifth day, with copious sweating or expectoration.

A catarrhal epidemic, in which the disease assumed, in frequent instances, a regular intermittent character, with paroxysms occurring daily at a particular hour, and which yielded to the sulphate of quinia, is described by Dr. Samuel Webber, of Charlestown, N. Hampshire. (Boston Med. and Surg. Journ., xxxviii. 149.)

Epidemic catarrh cannot be considered as a dangerous disease. It is scarcely ever fatal, unless complicated with inflammation of the brain, lungs, or heart, or in persons debilitated by old age, or previous maladies, such as chronic catarrh, phthisis, and organic cardiac affections. It occasionally also proves fatal in infants. But, though thus mild in its character, it affects so large a number of individuals, and so many persons in every community are just tottering on the brink of the grave, that it proves the immediate cause of numerous deaths whenever it prevails. Thus, in some places, it is asserted to have proved more fatal in reference to the community at large than even cholera, in consequence of the vastly greater number of persons affected. It has been estimated that, of those attacked by the influenza in its different forms, about two out of every hundred perish.

Causes. The peculiar nature of this epidemic influence has been a subject of much conjecture and discussion, but has not yet been satisfactorily explained. Some have supposed that it might consist in those atmospheric vicissitudes which have often been observed to accompany the epidemic; but this notion is contradicted by the fact, that the disease has occurred under all possible varieties of appreciable atmospheric condition, at all seasons, in all weathers, and at the same moment in distant places, differing wholly in climate, and the state of the atmosphere at the time. The ascription of the disease to a peculiar electrical state of the air is equally unsatisfactory; for no such state has been shown to exist in connexion with it. That the cause cannot be an exhalation from the earth is proved by its rapid passage from one country to another, from the immense extent of its prevalence, and from the fact, that it acts in the midst of the ocean, which no such exhalation would be apt to reach. The notion of some uncertain telluric influence is too vague to require refutation. Nor does the idea of contagion, though entertained by so high an authority as Cullen, appear to deserve a much more serious notice. It is altogether beyond modern credulity, that a disease which sweeps like a tempest over nations, and prostrates whole communities almost at the same moment, should be propagated by communication from individual to individual. That, though occurring epidemically, it may still have contagious properties, like

measles and scarlatina, is another matter, and not so obviously absurd. But there is no good reason even for this modified belief. A contagious disease usually attacks some one individual in a family, and after a certain interval extends to others. The influenza commonly seizes at once upon the whole family. The vicinity of the sick has not been shown in any degree to favour the occurrence of the disease. Contagious affections communicated through the atmosphere usually occur but once. An attack of influenza is no security against subsequent attacks. Contagion lingers long after the epidemic has passed. Influenza leaves few or no straggling cases behind it; unless those of individuals who may suffer relapses from cold or other cause. It is said that the disease has been observed to commence in certain places after the arrival of strangers from infected neighbourhoods, and to spread from the point of arrival. This might happen fifty times, and yet be purely accidental. At present very few believe that the disease is in any degree contagious. The last notion which has been advanced as to the nature of the epidemic cause, is that it is organic, consisting of innumerable animalcules or vegetable microscopic fungi, which have the power of propagating rapidly in the atmosphere, but run a brief course of existence. There is some plausibility in this idea. It explains many of the extraordinary movements of the epidemic, and accounts for the asserted fact of individuals from infected districts becoming the centre of a new prevalence elsewhere. They may bring about their persons, or in their baggage, organic germs, which may soon fill the atmosphere with their progeny. But this hypothesis is wholly destitute of proof; for the as sertion that immense swarms of visible insects sometimes appear during the catarrhal epidemic, even if its truth be admitted, goes but a very little way towards proving that the epidemic cause consists in insects that are invisible. It is best then at once to confess our ignorance on this point, and to wait patiently until we can obtain new light.

Treatment. In relation to the treatment it is necessary to say but little. The disease must be managed in the same way essentially as common catarrh. (See coryza, laryngitis, and bronchitis.) There is one prominent difference, however, which requires notice. Almost all writers agree that the influenza does not so well tolerate depletion. Bleeding is not borne well, or if borne. is said to be less effective. In abstracting blood, therefore, it is proper to be cautious, and always carefully to examine the pulse. If this begin to falter, the bleeding should be immediately checked. As a general rule, unless the symp toms of inflammation are decided, it is best to avoid venesection altogether, and to trust chiefly to the diaphoretic plan. Even active purgation is scarcely admissible. Eupatorium, or boneset, has long been recommended in this disease. Dr. Peebles (Am. Journ. of the Med. Sci., N. S., vii. 365) speaks in the highest terms of its utility. He employed it in many cases exclusively, and found it useful by its sudorific, laxative, and emetic properties, when adminis tered early in the complaint, in the form of warm infusion; and by its tonic powers, when given in cold infusion in the advanced stage. When diarrboa occurs in the latter stages, it may be arrested by means of opium and ipecacuanha. When the debility is considerable, it is often necessary to support the system by tonics, aromatics, and even more powerful stimulants. Should the disease assume a regular periodical character, sulphate of quinia would be indicated.