married late in life, and entered upon free indulgence. What pathological knowledge we may possess will now come into exercise. We have to explore the symptoms to their origin, to judge the actual condition of the patient, and decide in regard to the causes. This may lead to a series of questions, which will readily come to the mind of the intelligent physician, as necessary in order to ascertain the state of facts. We must be able to judge whether the condition exists which will tend to effect morbid changes evinced by the symptoms enumerated. Every just consideration, the interest of health, the conscientiousness of the true physician in the performing of his duty, will not permit a false and unscientific modesty to hold us back from putting searching questions as will determine the actual facts in regard to the patient. If this is properly disclosed the treatment is easily adapted, and in this connection requires no particular mention.

Thus in brief outline, I have given some ideas on this subject. I must confess, however, that the topic demands some master's hand for its proper elucidation. What I have stated will indicate that it is eminently worthy of a thorough and detailed treatment in our medical works. It is high time that some one qualified for this undertaking shall prepare a treatise which will discuss the entire subject, explaining and enforcing the relationship mentioned, and specify in detail the forms of nervous disease, either directly or indirectly traceable to the male genital function. It is a graver matter than many seem to imagine.

TYPHO-MALARIAL FEVER.

By HENRY PARKER, M.D., Berea, Ohio.

The Valley of the Mississippi, especially the lower districts, is the home of malarial fever in all its types, from the mild "dumb ague" to the black vomit of yellow fever. But true typhus is seldom encountered in what may be considered as malarial regions. The Eastern States and the provinces com

prising the Dominion of Canada, the high northern latitudes, would seem to be the home of typhus, if there is any. In a practice extending over more than thirty years, I never met with but a single case, and that was imported from Canada. But where the latitude and longitude of "typho-malarial fever" may be found is a question.

As for the designation, typhoid fever, which is so generally employed, I consider it a misnomer. In what characteristic is it typh-oid-resembling typhus? I have observed none, except the duration of the attack. The distinctive symptoms are the inflammation of Peyer's and Bruno's glands in the small intestine. They are always absent in typhus. Indeed, the supposed sources of the two complaints are dissimilar. Typhus is a nervous fever, largely incited by malarial poison, while the complaints known as typhoid have their origin in the exhalations of decomposing animal substances. The sewer and ill-kept cess-pool, and the unclean and unventilated sick-chamber, afford the most common facilities for the pur

pose.

All the types of malarial fever have been carefully and critically described by writers on practice, and their classification has been generally accepted. Every case has its own peculiar determination, and it varies, manifesting itself in one part or organ of the body or another, as the liability to the morbid influence happens to preponderate.

Why should a new name be adopted-a name which is without pertinence, and conveys no special meaning? Suppose we should adopt the designation typho-malarial; whence comes the prefix, typho? If it is taken from typhoid, it denotes one thing; if from typhus, it certainly must mean something entirely different. One writer has given the import and origin of the term or phrase, that it was originated in the late civil war, and signified a disorder with threefold cause, namely: malaria, poison from overcrowding, and scorbutic taint. If this is correct, how can we have a disease all over the country, every season, that could be properly designated typho-malarial fever? There may be the malaria to induce it; the scorbutic taint, however, but seldom; the crowd-poison, never.

men.

I reject the name entirely. It should not be used by medical If it is ever generally adopted in our literature and technology, the effect will be to confuse, to mix up ideas, and add nothing to our knowledge or the facility of acquiring it. A name will be added to the nomenclature of medicine, always extended unnecessarily to preposterous dimensions, and serving chiefly to illustrate the general scientific ignorance of medicine and disease. But, with the new name, there will be no new idea or other corresponding advantage. Indeed, so far as my observation extends, it has been adopted and used by a class of medical practitioners to mystify, to cover up their ignorance, and shirk or evade the responsibility of unsuccessful practice. By pretending on every possible occasion that a complaint is typhoid, they may, if the patient recovers, make a little capital out of the public credulity. In case their patient dies, they have, as the convenient outlet of escape, the pretext that the case was typhoid at the outset, and so, consequently, there was little or no hope.

One fact in treatment illustrates the accurateness of my conviction. Quinia is generally employed in all types and stages of malarial fever. But it is anything except a proper remedy in a typhoid attack. It will neither abort it nor be in any respect beneficial. On the other hand, it will promote and increase delirium, as well as produce other mischief.

As I have thus unequivocally discarded the new-fangled term, I shall be exonerated from giving any pathology. It is a subject which belongs to other hands. Somebody who believes in it is the proper person to undertake the task. If no such individual is found, it may be a fortunate matter for the Committee on Nomenclature of Diseases.

ECCHYMOSIS AND OTHER EFFUSIONS OF BLOOD

CAUSED BY NERVOUS INFLUENCE.

By HENRY WOHLGEMUTH, M. D., Springfield, Illinois.

The term ecchymosis signifies a complaint consisting in.an extravasation, effusion or collection of blood, as it may be termed, under the skin, making its appearance, more or less, upon various parts of the body. It may show itself by a minute or more prominent discoloration, a collection, and elevation of the integument, occupying a space over or about different parts of the body, in appearance of a violet, bluish or black color. It causes no particular pain, and usually disappears in a few days. The blood thus confined liberates itself in due course of time by re-absorption. It rarely ever suppurates; nor does it cause great inconvenience, if any, except in cases of bad habits, such as intemperance, uncleanliness, neglect of person, the occupying of damp places, impure air, the keeping of the body too warm, by an undue amount of clothing, etc. All this may not excite any alarm, and the attention of the patient so afflicted may not be awakened to its importance. Nevertheless, it is not at all improbable that sluggishness of the circulation, if not mortification of the parts so affected, may ensue. It is well, therefore, that the physician should give attention to the matter.

It is a morbid state of the circulation of the blood, and as it may not seem to require our attention as being of much importance, yet it must be apparent to any one so afflicted, or to those familiar with cases of this kind. Life as it is understood implies an active state, and a concurrent exercise of the functions of the body. This being the case, it is also necessary that there should be a corresponding and a healthy condition of the mind. Any deviation from this, whether it be considered a functional or organic derangement, is a deviation from a state of health, consisting, for the most part, in a change, either the structure of any tissue, membrane or organ. It may be taken for granted that the ailment under consideration, exists mainly in a disorder of the circulation, causing a

discoloration of the integument; indicating that we have to contend with a functional disorder, owing to a large extent, not only to a want of proper circulation of the blood, but also to a want of proper action of the skin. The pathological condition may be regarded as being of consequence, as membranes and tissues may be individually diseased, while neighboring membranes and tissues remain apparently unaffected. While it may be looked upon, as a mere functional disturbance in the economy, we should not lose sight of its constitutional relations. In a majority of cases, there is an impairment in the functional arrangement of the organs of the body. Numerous instances are also found in which, not the body alone, but the mind, is also at fault, and we have a structural and functional disturbance, not generally common in all forms of a diseased condition.

We may take a case of apoplexy. There we will find that the interruption of the nervous communication may produce hæmorrhage, whilst there is going on an influx of blood into the brain, although an active one. Yet we find it brings about a general loss of sense and motion, and we are apt to find a morbid appearance and discoloration of the skin; and that, too, at times, very sudden and unexpectedly. There is instantaneous suspension or exhaustion of nerve-power, without which, there is not, and cannot be any vigor of other parts. The consequence is, that there is no activity; the tonicity being lost to keep back the ingress or flowing of blood to the arteries and veins of the brain. Nor can it free itself of the undue excess of blood already there. The vessels have become full and distended to their utmost capacity. It is imperatively necessary to relieve these vessels of this excess of blood. If nature should not relieve them of their burden, distended and engorged as they are, we will surely find that something must give way. Some of the vessels will be likely to burst; and if they do not, then this excessive flow must be intercepted or terminated, which can only be accomplished, if at all, by and through the influence which the organic or sympathetic nerves exert upon the blood-vessels.

We will also find in cases of headache, that it is frequently