The cause of the disease was formerly thought to be the influence of the stars, but more recently has been attributed to the bacillus of influenza, described by Pfeiffer in 1892. It was long claimed to come from the east, but now to travel in different directions. The symptoms of influenza are more numerous and protcan than those of any other acute disease. Its onset is usually rapid and severe. The well suddenly become sick-very sick. The pulse is rapid, temperature high and respirations hurried, sometimes with dyspnea. There may be chills or rigors, with the skin moist or dry. The tongue is coated, appetite gone, and there may be nausea and vomiting. Constipation is the rule, but diarrhea is often a symptom. Headache, vertigo, and even delirium may exist, while epistaxis is of frequent occurrence. Coryza, sneezing, lachrymation, hoarseness, cough, sore throat, may any or all be symptoms. Pains in the left hypochondriac region are frequently troublesome, as also are those in the neck, chest, back and limbs, and there is a feeling of general soreness, described by the patient as "I feel as if I had been pounded all over." Earache and inflammation of the eyes occur. Skin eruptions are frequent symptoms, from the flea-bite red spot to a similarity to scarlet fever, measles and a mottled or marbled appearance over the body. Swelling over the eyebrows has been noticed. The patient feels very weak, and is apt to have gloomy feelings and be despondent.

From the enumeration of symptoms it might be conjectured that a diagnosis is very difficult to make; but to the experienced such is not the case. There is usually so many cases alike at the same time, and such a profusion of symptoms, simulating several severe diseases, that it is an easy matter to name influenza. The symptoms in from two to seven days disappear, by lysis rather than by crisis, leaving the patient weak. Once having influenza is no preventive against another attack, and relapses are not uncommon.

The prognosis in uncomplicated cases is favorable, except in the young, the old and the feeble. And, I think, when we have complications they are due generally to diseases existing,

or tending to exist, before the attack of influenza, rather than to new diseases. People suffering with catarrhs of the upper air passages are apt to suffer more from influenza in the same localities, while those having heart, lung or bowel troubles, when influenza attacks them find the previous ailments made worse.

The treatment of influenza is nearly as badly mixed as are the symptoms. But it has been fairly well learned that rest, tonics and time work speedier and more perfect cures than do the depletory and antiphlogistic remedies. It may be advisable at the beginning of the sickness to administer a dose of calomel, to move the bowels, and follow it with tonic doses of quinin. If the fever persists in remaining above 103, a few small doses of aconite may be of assistance. But frequent sponging with water in which may be salt or alcohol and of the temperature most agreeable to the patient seems to work better. If cough is troublesome and pains complained of and the patient restless, small doses of Tully's powder or bromid of potash has a good effect. Chlorate of potash or other mouth wash is pleasing to the patient. Milk, eggs and broths should be given regularly and often. Patients who go to bed as soon as attacked and remain there until the symptoms abate do best.

DISCUSSION.

Dr. A. W. STINCHFIELD—I had supposed the discussion would be carried out according to the program, because I noticed on the program a list of men who were to discuss these papers, and I have prepared nothing to say on the subject. There is one thing that occurs to me that I might mention at this time. I have seen quite a number of patients that date their ill health entirely to an attack of influenza, having always been well previously. In quite a few of these cases the lesion has been that of the heart, myocarditis.

DR. A. C. KELSEY-I think the last suggestion in the paper we have just listened to is a very valuable one, that the patients remain in bed. I have had more difficulty with relapses than with the primary trouble, and relapses came always with people whom it is impossible to keep quiet as long as they should be. As far as the cough is concerned, that is the trouble with my patients also, and I have never found a satisfactory remedy for it. It seems to be a nervous cough not affected by the ordinary cough remedies. If any

member can suggest a line of treatment for that cough he will certainly greatly oblige me.

DR. T. J. CATLIN (Essayist)—I would like to have heard some more discussion on the subject. To me this is a very important disease. We see more "grip," as people call it, than any other disease, and it seems to me other members of the society should be able to discuss this subject from the light of their experience. That is one reason why I wrote the paper, because I wanted to learn something more about it myself.

REPORT OF A CASE OF PERNICIOUS ANEMIA FOLLOWED BY APPARENT RECOVERY.

C. A. ANDERSON, M.D., RUSH CITY.

Pernicious anemia, on account of its obscure origin, is a subject which has received a good deal of attention during the last few years. Quite a number of cases have been reported and their clinical course thoroughly studied, yet, as far as their origin is concerned, it must be admitted that we still have much to learn.

It seems probable, however, that recent investigations have indicated to us where we should direct our treatment, for although there are a great many theories as to what is the real cause of the disease, yet nearly all agree that the alimentary canal is in some way at fault and, therefore, ought to receive most of our attention. For this reason we may, perhaps, hope that the prognosis in the future may be a little more favorable than has been in the past. Within the last few years a few cases have been reported that have apparently been cured.

The case I am about to report is remarkable on account of the rapid improvement and apparent recovery.

C. J. was born in Sweden thirty years ago. Family history good, and was well until 9 years of age, when he was bitten in the right foot by a snake. The whole side of his body swelled very much. He was very ill for two weeks, delirious most of the time, remained in bed one month, and it took about six months before he regained his usual health. He came to America about five years ago. About three years ago he had an attack of facial erysipelas, which confined him to the house about two months. After that he remained well and was doing hard manual labor until about two weeks before he consulted me.

He first consulted me Jan. 5, 1903. He then complained of

a severe headache, which kept him awake nights, weakness and loss of appetite. There was also some epigastric pain, but no nausea nor vomiting. The breathing was rapid, the pulse fast, temperature 10012, there was a hemic murmur over the base of the heart, the spleen was not enlarged, nor was the liver. The bowels at this time were somewhat constipated. There was a very marked yellow discoloration of the skin, but this discoloration was not uniform, for in places the skin was of a milky whiteness. The lips and gums were very pale. Diagnosis, pernicious anemia, and treatment begun by giving him arsenic and iron.

January 12 patient was taken to Minneapolis to consult with Drs. J. W. Bell and S. P. Rees. His condition was about the same as before except that his temperature was 10112, and complained of ringing in his ears. An examination of the blood showed 750,000 red blood corpuscles to the cubic millimeter and hemoglobin 23 per cent. It will be noted that the decrease of red blood corpuscles was somewhat greater than the loss of hemoglobin. There was also present various forms of degenerated red cells, normoblasts, gigantoblasts, etc. His teeth were well preserved, and I noted nothing abnormal about the condition of his mouth.

On January 13, when the patient had returned to his home, he was put to bed and was given a generous diet. The following treatment was then begun: The arsenic was continued and iron in the form of Blaud's pills and also nux vomica. As an intestinal antiseptic he was given small doses of calomel. Every morning he was given a saline laxative and a couple of hours later a high rectal enema of normal salt solution. The arsenic was gradually increased, until at the end of three weeks he was taking 13 minims of Fowler's solution three times a day. This dose was continued until March 27, when the blood appeared to be normal. After that time he took arsenic on alternate weeks. The iron was continued for about four weeks, but he took nux vomica only about two weeks.

The saline laxative and calomel had to be discontinued