but the boy was from home till after his father's removal to the Hospital.

The constant absence of any evidences of intestinal disease in typhus was confirmed by a report published by Dr. Reid* of the pathology of fever in Edinburgh in 1842, which embraced no less. than 100 examinations; and in 1843 + by one of myself, detailing the results of examination in 31 other cases. These several reports give a total of 161 cases of fever examined between the years 1838 and 1842, in only eleven of which was the follicular disease found, or in about 1 in 14 cases. Dr. Bennett, however, in 1846 and 1847, found the follicular disease more frequent in Edinburgh; or, in 19 out of 63 cases examined after death; but, as this report is not accompanied by any statement of the features of the cases during life, so far from invalidating the general conclusion, it only proves that, at the period in question, typhoid was usually prevalent in Edinburgh. Of the cases of fever in which the intestinal lesion was found, examined by Dr. Reid and myself, all were admitted into the Infirmary from districts adjacent to Edinburgh, and not from the town itself; or, if so, had come to Edinburgh laboring under the disease.

After having had my attention for several years specially directed to these points, I have seen no exception to the rule, that the fever characterized by the general features and eruption of typhus is unattended by any lesion of the intestinal mucous membrane; or that the equally marked disease characterized by the rose-spots of typhoid is as constantly connected with the follicular disease. These facts have also recently been confirmed by Dr. Wilks from his experience at Guy's Hospital; and similar evidence has been brought forward by other writers both in this country and in America.

At the time when Dr. Jenner's paper was read at the MedicoChirurgical Society in 1849, I was induced to look over the notes of the fever cases which I had treated at the Royal Free Hospital, to which institution I was then attached; and I found that, though these observations had not been collected with any reference to that investigation, in every instance where two or more members of the same family were admitted into the Hospital, the character of the fever corresponded in all the cases. Since this time, while I have been connected with St. Thomas's Hospital, I have equally directed my attention to this question. I have seen many instances in which several persons of the same family or from the same house, have been admitted with fever, or have been laboring under fever, and have found no exception to the rule, that all the cases in such instances corresponded in character. Very recently we have had several sets of cases of typhus occurring in members

*Lond. and Ed. Journal, 1842.

+ Lond. and Ed. Monthly Journal, 1843. Ibid. 1848, N. S. Vol. II., p. 299.

of the same family or in the same house; as, two patients under my care in Jacob's; three of a family under Dr. Bennett, Dr. Bristowe, and Dr. Goolden; and two of a family under Dr. Barker and Dr. Goolden. Yet in all these sets of cases the character

of the fever was identical.

We have also in the General Hospitals, the opportunity of observing what in the Fever Hospital could not be seen,-patients laboring under other diseases becoming affected by typhus, from their vicinity to typhus patients. Of the cases to which I have referred, in six the disease was thus contracted, and very recently three or four similar instances have occurred. In these cases the character of the fever always corresponds with that of the case from which the others are derived. I have, indeed, seen typhus affect persons under the most diverse circumstances,-old and young persons, medical students, nurses, persons in depressed state of health, from unhealthy districts of town, and others in robust general health, and fresh from the country; but I never observed any material modification of the character of the disease, though, of course, its intensity or malignity will vary. If, however, the poison of typhus and that of typhoid were the same, it is impossible to doubt that, instead of all the cases being characteristically cases of typhoid, some would be cases of typhus and some of typhoid; while others would present more or less of the characters of the two diseases.

I have recently treated a case, regarded as an ordinary instance of typhoid, and which passed favorably through the disease, and recovered, so that the patient was able to walk about the ward; he then was again taken with fever, having the usual features of typhus, and characterized by a typhous rash on the skin. In this instance, the patient lay in a bed near one occupied by a typhus patient, and appeared, during his convalescence from typhoid, to have contracted typhus. Facts of this kind must be regarded as strongly upholding the doctrine of the specific difference of the two diseases; for it is well ascertained, that both affections-like the eruptive fevers-confer, to a great degree, immunity from subsequent attacks.

Lastly, Dr. Jenner has shown that typhus and typhoid may be epidemic, at the same time, or the one disease may decline, while the other is becoming more prevalent, or vice versa; and we have continual opportunities of observing this to be the case. Often you will find many cases of typhoid in the Hospital, but only one or two of typhus; at other times, and such is now the case, the typhus cases will be much the most numerous.

With these various facts before us, there can be no longer much hesitation in adopting the conclusion, so ably illustrated, and, I think, fully established by Dr. Jenner, that typhus and typhoid are specifically distinct diseases. There may, it is true, be sometimes a difficulty in deciding as to which class a given case should be

assigned. The typhus eruption may be more discrete than usual, the spots may be more distinctly defined, and when they first appear may be usually elevated; and thus, at first sight, the eruption may bear a very close resemblance to that of typhoid. On the other hand, the eruption of rose-spots in typhoid may be mingled with a petechial eruption, which may assimilate it to the typhus rash; or, from the presence of other eruptions on the skin, the characters of either rash may be disguised. There may thus be difficulty in deciding as to the true nature of the eruption, but this difficulty will generally vanish on careful inspection, or, at any rate, on watching the progress of the case. I do not recollect to have ever failed to make up my mind as to the kind of eruption at the time I first saw the patient; or, on further examination a day or two after, to have found that the opinion first formed was incorrect. Were, however, the difficulty of distinguishing the two diseases much greater than it really is, this would not prove their identity; it would only show, as contended by M. Louis, that they formed no exception to the rule, that most diseases, even some of those which are the best understood, are occasionally difficult to discriminate.

While, however, typhus and typhoid are distinct diseases, they are, nevertheless, very closely allied. This, at first sight, might scarcely appear to be the case; for typhus presents the type of an essential fever, unconnected with local disease; while, typhoid is always associated with the intestinal affection. This difference is, however, more apparent than real; for in typhoid, as I have before mentioned, there is not any certain or constant relation between the intensity of the general symptoms and the amount of local disease. The intestinal affection can, therefore, only be regarded as one symptom or result of the essential disease. Both affections are thus closely allied to the eruptive fevers, while they are markedly distinct from the intermittent and remittent fevers dependent on malaria.

But it may be asked, what is the advantage of thus elaborately drawing the distinction between these two forms of fever? Much every way. In the first place, though the practical application should not be now apparent, the extension of our knowledge would yet be desirable; for it cannot be doubted that all advances in our acquaintance with diseases must ultimately prove useful in practice.

But the distinction between typhus and typhoid is one which is full of importance. The prognosis in the two diseases is different; and, though the principles which should guide our treatment may be similar in both, they must be greatly modified in their application by the peculiar character of each.-[N. Orleans Med. News and Hosp. Gaz.

The Effects of Dentition on Nursing Children. By M. TROUSSEAU. (Clinical Lectures delivered at the Hotel Dieu. Translated for the Boston Med. and Surg. Journal, from the Gaz. des Hopitaux, Dec. 1855.

REMARKS.—The subject of the following article, we consider of such deep interest to the practitioner, and the views therein expressed embody, in the main, so much of truth in regard to this important period of infantine existence, that we deem them worthy of something more than simple republication.

In order to form a proper appreciation of the subject of Dentition, we must look at this period in a somewhat different relation from those in which M. Trousseau has viewed it in the present article, viz., in its relation to the Nervous System. In a former number of this Journal (June, 1850, p. 321*) we had occasion to discuss, at length, the influence of Dentition in producing the Cholera Infantum of this period, and the observation of the six years, elapsed since that time, has only served to confirm the views we then expressed in reference to the agency of the nervous system. It is in this relation, we apprehend, that most of the interest attaching to this period is to be found; and, in our opinion, all the evils resulting, as the effects of teething, are referrible to this system, in one or the other of two ways: the irritation may be transmitted from the gums, 1stly, through the cerebro-spinal system to the voluntary muscles, and give rise to the convulsive affections and paralysis of this period; and 2ndly, the irritation may be transmitted from the gums, through the ganglionic system of nerves, to the various vascular organs, as the lungs and liver, and secretory surfaces, as the gastric and intestinal mucous membrane-— giving rise to congestions, in the one case, and excessive secretion, diarrhoea and cholera infantum, in the other. "A few days before it (meaning diarrhoea) begins," says M. Trousseau, "the infant is restless, wakeful, cries violently, sucks its fingers, bites the nipple, refuses to feed, if it takes supplementary nourishment, and sometimes will not nurse. Its gums are red, and there is very evident prominence at the points which the teeth are about to pierce; there is cough, the voice is changed, the mucous membrane of the mouth is irritated."

Here it will be observed that we have unmistakable evidences of local irritation in the gums, which we know are supplied by

"An Essay on the Influence of Dentition in Producing Disease."

branches of that most exquisitely sensitive of all sensitive nerves, the fifth pair; if we admit the principle of reflex action, we must recognise here a competent cause, considering the impressible character of the infants nervous system, for convulsive phenomena. On the other hand, we may trace a connection between this local irritation and the diarrhea succeeding it, in an analogous manner, taking into view the intimate connections existing between this fifth pair, aud the nerves of the ganglionic nervous system, from which the intestinal mucous surfaces receive their secretory endowments.

We have been thus careful in pointing out the manner in which we think this local irritation may produce the convulsive symptoms, and also even the increased secretion from the mucous surface of the bowels and the diarrhoea, in order to give it what we consider its proper amount of importance, and to direct attention to this, as the chief source of those difficulties, calling for early and continued care.

Throughout the whole of his communication, M. Trousseau does not refer once, to the measure of incising the gums, as a means of relief. This, it is needless to say, is ever in this country deemed an important means of relieving the local irritation, but one we think too often neglected. Opiates also, as a means of quieting irritation may be mentioned, but we have found great caution necessary in their administration.

We have little doubt, that the character of the symptoms and the phases, assumed by the diseases incident to dentition, are much modified by climate. In those regions where paroxysmal diseases prevail, the symptoms will partake of the general character of these diseases, and become, in a great degree, amenable to the influence of quinine. This is more especially true of the convulsive diseases attending dentition, which manifest a great disposition to recur, unless treated with quinine, after the manner of paroxysmal fever.

"It has been said," again remarks our author, "that convul sions are common with infants whose bowels are constipated, but do not attack those who have diarrhoea. This is not true. Convulsions almost always accompany diarrhoea and are prevented by a good state of the bowels."-From this opinion, our own observation, and doubtless that of most Southern practitioners, would incline us to dissent. We have uniformly found, where there was much irritation in the gums, and this unaccompanied by diarrhoea,