115 



the differences depending on circumstances, in many cases, beyond 

 the reach of control. In the Ncav York hospital, as it is stated in 

 the last annual report of the governors of that institution, "the num- 

 ber of typhus fever cases treated during the year, was 1,084; very 

 many of them cases of the severest form of the disease, and demand- 

 ing far more than the ordinary assistance of physicians and nurses. 

 Of this number 136, or a little more than thirteen in the hundred, 

 have died. This result, though it appears to be a large proportion, 

 bears a very favourable comparison with the statistics of any other 

 sanitary establishment under similar circumstances of disease, and 

 affords a very striking contrast to the terrible mortality from the 

 same cause among the recent emigrants from Europe in other parts 

 of the continent." But though the amount of mortality has been in- 

 fluenced by the circumstances in which the sick in hospitals were 

 placed, it is to be noticed that the proportion of deaths has been 

 greater among those in the higher than among those in the lower 

 ranks of life, a fact generally observed in the typhus epidemics of 

 Europe. 



With these remarks on the typhus or ship fever of the last year, 

 we might close our report, were it not that a question of more than 

 ordinary interest, relating to this subject, demands from us a care- 

 ful examination, — a question on which the profession in this country 

 and in Europe are divided, and which, it is thought, the phenomena 

 of the recent typhus epidemic, added to the facts afforded by former 

 prevalences of the disease, have largely contributed to elucidate. It 

 needs hardly to be stated that we refer to the question of the identity 

 or non-identity of typhus, and a form of disease entitled typhoid 

 fever. That there are two forms of fever, bearing these names, 

 which closely resemble each other, and yet which are essentially dis- 

 tinct in their nature, is alleged by some of the most renowned patholo- 

 gists of the age. The leading distinctive features of the two diseases 

 are, it is affirmed, intumescence and generally ulceration of Peyer's 

 glands, and certain other morbid conditions, in one of them, and the 

 total absence of these phenomena in the other. 



Now if, in fact, two such diseases exist in nature, the committee, 

 in what they have submitted concerning epidemic typhus, have omit- 

 ted to distinguish them, or, in other words, have committed an error 

 in confounding distempers specifically dissimilar; for everywhere 

 have the two forms of disease been associated and looked upon as 

 one and the same malady. The attempt to rectify such an error, if 

 such have been made, would involve the necessity of giving the history 



