Medical Terms and Definitions

A

Abscess.  A localized collection of pus buried in tissues, organs, or confined spaces of the body, often accompanied by swelling and inflammation and frequently caused by bacteria.  The brain, lung, or kidney (for instance) could be involved.  See boil.

Addison's disease.  A disease characterized by severe weakness, low   blood pressure, and a bronzed coloration of the skin, due to decreased secretion of cortisol from the adrenal gland.  Dr.  Thomas Addison (1793?1860), born near Newcastle, England, described the disease in 1855.  Synonyms:  Morbus addisonii, bronzed skin disease.

Ague.  Malarial or intermittent fever characterized by paroxysms (stages of chills, fever, and sweating at regularly recurring times) and followed by an interval or intermission whose length determines the epithets:  quotidian, tertian, quartan, and quintan ague (defined in the text).  Popularly, the disease was known as "fever and ague,"  "chill fever," "the shakes," and by names expressive of the locality in which it was prevalent??such as, "swamp fever" (in Louisiana),
  "Panama fever," and "Chagres fever."
 
Ague?cake.  A form of enlargement of the spleen, resulting from the action of malaria on the system.

Anasarca.  Generalized massive dropsy.  See dropsy.

Aphthae.  See thrush.

Aphthous stomatitis.  See canker.

Ascites.  See dropsy.

Asthenia.  See debility.

B

Bilious fever.  A term loosely applied to certain enteric (intestinal) and malarial fevers.  See typhus.

Biliousness.  A complex of symptoms comprising nausea, abdominal discomfort, headache, and constipation formerly attributed to excessive secretion of bile from the liver.

Boil.  An abscess of skin or painful, circumscribed inflammation of the skin or a hair follicle, having a dead, pus?forming inner core, usually caused by a staphylococcal infection.  Synonym:  furuncle.

Brain fever.  See meningitis, typhus.

Bronchial asthma.  A paroxysmal, often allergic disorder of breathing,  characterized by spasm of the bronchial tubes of the lungs, wheezing, and difficulty in breathing air outward often accompanied by coughing and a feeling of tightness in the chest.  In the nineteenth century the direct causes were thought to be dust, vegetable irritants, chemical vapors, animal emanations, climatic influences, and bronchial inflammation??all of which were reasonable guesses.  The indirect causes were thought to be transmissions by the nervous system or by the blood from gout, syphilis, skin disease, renal disease, or
heredity.  Only the latter cause was a reasonable assumption.

C

Camp fever.  See typhus.

Cancer.  A malignant and invasive growth or tumor (especially tissue that covers a surface or lines a cavity), tending to recur after excision and to spread to other sites.  In the nineteenth century,  physicians noted that cancerous tumors tended to ulcerate, grew constantly, and progressed to a fatal end and that there was scarcely a tissue they would not invade.  Synonyms:  malignant growth,
carcinoma.

Cancrum otis.  A severe, destructive, eroding ulcer of the cheek and lip, rapidly proceeding to sloughing.  In the last century it was seen in delicate, ill?fed, ill-tended children between the ages of two and five.  The disease was the result of poor hygiene acting upon a debilitated system.  It commonly followed one of the eruptive fevers and was often fatal.  The destructive disease could, in a few days, lead to gangrene of the lips, cheeks, tonsils, palate, tongue, and even half the face; teeth would fall from their sockets, and a horribly fetid saliva flowed from the parts.  Synonyms:  canker, water canker, noma, gangrenous stomatitis, gangrenous ulceration of the mouth.

Canker.  An ulcerous sore of the mouth and lips, not considered fatal today.  Synonym:  aphthous stomatitis.  See cancrum otis.

Carcinoma.  See cancer.

Catarrh.  Inflammation of a mucous membrane, especially of the air passages of the head and throat, with a free discharge.  It is characterized by cough, thirst, lassitude, fever, watery eyes, and increased secretions of mucus from the air passages.  Bronchial catarrh was bronchitis; suffocative catarrh was croup; urethral catarrh was gleet; vaginal catarrh was leukorrhea; epidemic catarrh   was the same as influenza.  Synonyms:  cold, coryza.

Childbirth.  A cause given for many female deaths of the century.  Almost all babies were born in homes and usually were delivered by a family member or a midwife; thus infection and lack of medical skill  were often the actual causes of death.
 
Cholera.  An acute, infectious disease, endemic in India and China and  now occasionally epidemic elsewhere characterized by profuse diarrhea, vomiting, and cramps.  It is caused by a potent toxin discharged by the bacterium Vibrio cholerae, which acts on the small intestine to cause secretion of large amounts of fluid.  The painless, watery diarrhea and the passing of rice water stool are  characteristic.  Great body salt depletion occurs.  Cholera is spread by feces contaminated water and food.  Major epidemics struck the United States in the years 1832, 1849, and 1866.  In the 1830s the causes were generally thought to be intemperance in the use of ardent spirits or drinking bad water; uncleanness, poor living or crowded and ill ventilated dwellings; and too much fatigue.  By 1850 cholera was thought to be caused by putrid animal poison and miasma or pestilential vapor rising from swamps and marshes or that it entered
the body through the lungs or was transmitted through the medium of clothing.  It was still believed that it attacked the poor, the dissolute, the diseased, and the fearful while the healthy, well-clad, well-fed, and fearless man escaped the ravages of cholera.

Cholera infantum.  A common, noncontagious diarrhea of young children,   occurring in summer or autumn.  In the nineteenth century it was considered indigenous to the United States; was prevalent during the hot weather in most of the towns of the middle and southern states, as well as many western areas; and was characterized by gastric pain, vomiting, purgation, fever, and prostration.  It was common among the poor and in hand?fed babies.  Death frequently occurred in three to five days.  Synonyms:  summer complaint, weaning brash, water gripes, choleric fever of children, cholera morbus.

Chorea.  Any of several diseases of the nervous system, characterized by jerky movements that appear to be well coordinated but are performed involuntarily, chiefly of the face and extremities.  Synonym:  Saint Vitus' dance.

Chronic.  Persisting over a long period of time as opposed to acute or sudden.  This word was often the only one entered under "cause of death" in the mortality schedules.  The actual disease meant by the  term is open to speculation.

Colic.  Paroxysmal pain in the abdomen or bowels.  Infantile colic is benign paroxysmal abdominal pain during the first three months of life.  Colic rarely caused death; but in the last century a study reported that in cases of death, intussusception (the prolapse of one part of the intestine into the lumen of an immediately adjoining part) occasionally occurred.  Renal colic can occur from disease in the kidney, gallstone colic from a stone in the bile duct.

Congestion.  An excessive or abnormal accumulation of blood or other  fluid in a body part or blood vessel.  In congestive fever (see text),  the internal organs become gorged with blood.

Consumption.  A wasting away of the body; formerly applied especially to   pulmonary tuberculosis.  The disorder is now known to be an infectious  disease caused by the bacterial species Mycobacterium tuberculosis. Synonyms:  marasmus (in the mid?nineteenth century), phthisis.

Convulsions.  Severe contortion of the body caused by violent, involuntary muscular contractions of the extremities, trunk, and head.  See epilepsy.

Coryza.  See catarrh.

Croup.  Any obstructive condition of the larynx (voice box) or trachea   (windpipe), characterized by a hoarse, barking cough and difficult   breathing occurring chiefly in infants and children.  The obstruction could be caused by allergy, a foreign body, infection, or new growth (tumor).  In the early nineteenth century it was called cynanche trachealis.  The crouping noise was similar to the sound emitted by a chicken affected with the pip, which in some parts of Scotland was called roup; hence, probably, the term croup.  Synonyms:  roup, hives, choak, stuffing, rising of the lights.
 

D

Debility.  Abnormal bodily weakness or feebleness; decay of strength.   This was a term descriptive of a patient's condition and of no help in making a diagnosis.  Synonym:  asthenia.

Diphtheria.  An acute infectious disease caused by toxigenic strains of  the bacillus Corynebacterium diphtheriae, acquired by contact with an infected person or a carrier of the disease.  It was usually confined to the upper respiratory tract (throat) and characterized by the formation of a tough membrane (false membrane) attached firmly to the underlying tissue that would bleed if forcibly removed.  In the nineteenth century the disease was occasionally confused with scarlet  fever and croup.
 
Dropsy.  A contraction for hydropsy.  Edema, the presence of abnormally large amounts of fluid in intercellular tissue spaces or body cavities.  Abdominal dropsy is ascites; brain dropsy is hydrocephalus; and chest dropsy is hydrothorax.  Cardiac dropsy is a symptom of  disease of the heart and arises from obstruction to the current of  blood through the heart, lungs, or liver.  Anasarca is general fluid accumulation throughout the body.

Dysentery.  A term given to a number of disorders marked by inflammation of the intestines (especially of the colon) and attended by pain in the abdomen, by tenesmus (straining to defecate without the ability to do so), and by frequent stools containing blood and mucus.  The causative agent may be chemical irritants, bacteria, protozoa, or parasitic worms.  There are two specific varieties:  (1) amebic dysentery caused by the protozoan Entamoeba histolytica; (2) bacillary   dysentery caused by bacteria of the genus Shigella.  Dysentery was one of the most severe scourges of armies in the nineteenth century.  The several forms of dysentery and diarrhea accounted for more than one-fourth of all the cases of disease reported during the first two years of the Civil War.  Synonyms:  flux, bloody flux, contagious pyrexia (fever), frequent griping stools.
 

E

Eclampsia.  A form of toxemia (toxins or poisons in the blood) accompanying pregnancy, characterized by albuminuria (protein in the urine), by hypertension (high blood pressure), and by convulsions.  In the last century, the term was used for any form of convulsion.

Edema.  See dropsy.

Effluvia.  Exhalations or emanations, applied especially to those of  noxious character.  In the mid?nineteenth century, they were called "vapours" and distinguished into the contagious effluvia, such as rubeolar (measles); marsh effluvia, such as miasmata; and those arising from animals or vegetables, such as odors.

Emphysema, pulmonary.  A chronic, irreversible disease of the lungs, characterized by abnormal enlargement of air spaces in the lungs and  accompanied by destruction of the tissue lining the walls of the air sacs.  By 1900 the condition was recognized as a chronic disease of  the lungs associated with marked dyspnea (shortness of breath),  hacking cough, defective aeration (oxygenation) of the blood, cyanosis  (blue color of facial skin), and a full and rounded or "barrel?shaped"  chest.  This disease is now most commonly associated with tobacco smoking.
 
Enteric fever.  See typhoid fever.

Epilepsy.  A disorder of the nervous system, characterized either by  mild, episodic loss of attention or sleepiness (petittnal) or by severe convulsions with loss of consciousness (grand mal).  Synonyms: falling sickness, fits.

Erysipelas.  An acute, febrile, infectious disease, caused by a specific  group ~4 streptococcus bacterium and characterized by a diffusely  spreading, deep-red inflammation of the skin or mucous membranes  causing a rash with a well?defined margin.  Synonyms:  Rose, Saint Anthony's Fire (from its burning heat or, perhaps, because Saint Anthony was supposed to cure it miraculously).
 

F

Flux.  See dysentery.
 
Furuncle.  See boil.
 

G

Gangrene.  Death and decay of tissue in a part of the body, usually a limb, due to injury, disease, or failure of blood supply.  Synonym:  mortification.

Gleet.  See catarrh.

Gravel.  A disease characterized by multiple small calculi (stones or concretions of mineral salts) which are formed in the kidneys, passed along the ureters to the bladder, and expelled with the urine.  Synonym:  kidney stone.
 

H

Hectic fever.  A daily recurring fever with profound sweating, chills,  and flushed appearance?? often associated with pulmonary tuberculosis or septic poisoning.

 
Hives.  A skin eruption of wheals (smooth, slightly elevated areas on the skin) which is redder or paler than the surrounding skin.  Often  attended by severe itching, it usually changes its size or shape or  disappears within a few hours.  It is the dermal evidence of allergy.  See the discussion under croup; also called cynanche trachealis.  In  the mid-nineteenth century, hives was a commonly given cause of death  of children three years and under.  Because true hives does not kill, croup was probably the actual cause of death in those children.

Hospital fever.  See typhus.

Hydrocephalus.  See dropsy.

Hydrothorax.  See dropsy.
 

I

Icterus.  See jaundice.

Inanition.  Exhaustion from lack of nourishment; starvation.  A condition characterized by marked weakness, extreme weight loss, and a decrease in metabolism resulting from severe and prolonged (usually weeks to months) insufficiency of food.

Infection.  The affection or contamination of a person, organ, or wound with invading, multiplying, disease-producing germs; such as bacteria, rickettsiae, viruses, molds, yeasts, and protozoa.  In the early part of the last century, infections were thought to be the propagation of disease by effluvia (see above) from patients crowded together.  "Miasms" were believed to be substances which could not be seen in any form; emanations not apparent to the senses.  Such miasms were  understood to act by infection.

Inflammation.  Redness, swelling, pain, tenderness, heat, and disturbed function of an area of the body, especially as a reaction of tissue to injurious agents.  This mechanism serves as a localized and protective response to injury.  The word ending -itis denotes inflammation on the part indicated by the word stem to which it is attached; that is, appendicitis, pleuritis, etc.  Microscopically, it involves a complex series of events, including enlargement of the sizes of blood vessels;   discharge of fluids, including plasma proteins; and migration of leukocytes (white blood cells) into the inflammatory focus.  In the last century, cause of death often was listed as inflammation of a  body organ; such as, brain or lung, but this was purely a descriptive term and is not helpful in identifying the actual underlying disease.
 
Intussusception.  The slipping of one part within another, as the prolapse of one part of the intestine into the lumen of an immediately adjoining part.  This leads to obstruction and often must be relieved by surgery.  Synonym:  introsusception.
 

J

Jail fever.  See typhus.

Jaundice.  Yellow discoloration of the skin, whites of the eyes, and mucous membranes, due to an increase of bile pigments in the blood; often symptomatic of certain diseases, such as hepatitis, obstruction of the bile duct, or cancer of the liver.  Synonym: icterus.
 

K

Kidney stone.  See gravel.

Kings evil.  A popular name for scrofula.  The name originated in the time of Edward the Confessor, with the belief that the disease could be cured by the touch of the king of England.
 

L

Lockjaw.  Tetanus, a disease in which the jaws become firmly locked together.  Synonyms:  trismus, tetanus.
 

M

Malignant fever.  See typhus.

Marasmus.  Malnutrition occurring in infants and young children, caused by an insufficient intake of calories or protein and characterized by thinness, dry skin, poor muscle development, and irritability.  In the mid-nineteenth century, specific causes were associated with specific ages:  In infants under twelve months old, the causes were believed to be unsuitable food, chronic vomiting, chronic diarrhea, and inherited syphilis.  Between one and three years, marasmus was associated with rickets or cancer.  After the age of three years, caseous (cheeselike) enlargement of the mesenteric glands (located in the peritoneal fold
attaching the small intestine to the body wall) became a given cause of wasting.  (See tabes mesenterica.)  After the sixth year, chronic pulmonary tuberculosis appeared to be the major cause.  Marasmus is now considered to be related to kwashiorkor, a severe protein deficiency.

Meningitis.  Inflammation of the meninges (the three membranes covering the brain and spinal cord), especially of the pia mater and arachnoid; caused by a bacterial or viral infection and characterized high fever, severe headache, and stiff neck or back muscles.  Synonym: brain fever.

Morbus.  Latin word for disease.  In the last century, when applied to a   particular disease, morbus was associated with some qualifying adjective or noun, indicating the nature or seat of such disease. Examples:  morbus cordis, heart disease; morbus caducus, epilepsy or failing sickness.
 

N

Neuralgia.  Sharp and paroxysmal pain along the course of a sensory nerve.  There are many causes:  anemia, diabetes, gout, malaria, syphilis.  Many varieties of neuralgia are distinguished according to the part affected??such as face, arm, leg.
 

P

Paristhmitis.  See quinsy.

Petechial fever.  See typhus.

Phthisis.  See consumption.

Pleurisy.  Inflammation of the pleura, the membranous sac lining the chest cavity, with or without fluid collected in the pleural cavity. Symptoms are chills, fever, dry cough, and pain in the affected side (a stitch).

Pneumonia.  Inflammation of the lungs with congestion or consolidation???caused by viruses, bacteria, or physical and chemical agents.

Pus.  A yellow?white, more or less viscid substance found in abscesses and sores, consisting of a liquid plasma in which white blood cells are formed and suspended by the process of inflammation.

Putrid fever.  See typhus.

Putrid sore throat.  Ulceration of an acute form, attacking the tonsils and rapidly running into sloughing of the fauces (the cavity at the back of the mouth, leading to the pharynx).

Pyrexia.  See dysentery.
 

Q

Quinsy.  A fever, or a febrile condition.  An acute inflammation of the tonsils, often leading to an abscess; peritonsillar abscess.  Synonyms:  suppurative tonsillitis, cynanche tonsillaris, paristhmitis, sore throat.
 

S

Scarlatina.  Scarlet fever.  A contagious febrile disease, caused by infection with the bacteria group.  A beta-hemolytic streptococci (which elaborate a toxin with an affinity for red blood cells) and characterized by a scarlet eruption, tonsillitis, and pharyngitis.

Scrofula.  Primary tuberculosis of the lymphatic glands, especially those in the neck.  A disease of children and young adults, it represents a direct extension of tuberculosis into the skin from underlying lymph nodes.  It evolves into cold abscesses, multiple skin ulcers, and draining sinus tracts.  Synonym:  king's evil.

Septic.  Infected, a condition of local or generalized invasion of the  body by disease?causing microorganisms (germs) or their toxins.

Ship fever.  See typhus.

Spotted fever.  See typhus.

Suffocation.  The stoppage of respiration.  In the nineteenth century,   suffocation was reported as being accidental or homicidal.  The accidents could be by the impaction of pieces of food or other obstacles in the pharynx or by the entry of foreign bodies into the larynx (as a seed, coin, or food).  Suffocation of newborn children by smothering under bedclothes may have happened from carelessness as well as from intent.  However, the deaths also could have been due to SIDS (sudden infant death syndrome), wherein the sudden and unexpected death of an apparently healthy infant, while asleep, typically occurs between the ages of three weeks and five months and is not explained by careful postmortem studies.  Synonyms of SIDS:  crib death and cot death.  It was felt that victims of homicidal suffocation were chiefly infants or feeble and infirm persons.

Summer complaint.  See cholera infantum.

Suppuration.  The production of pus.
 

T

Tabes mesenterica.  Tuberculosis of the mesenteric glands in children,  resulting in digestive derangement and wasting of the body.

Teething.  The entire process which results in the eruption of the teeth.  Nineteenth-century medical reports stated that infants were more prone to disease at the time of teething.  Symptoms were  restlessness, fretfulness, convulsions, diarrhea, and painful and swollen gums.  The latter could be relieved by lancing over the protruding tooth.  Often teething was reported as a cause of death in infants.  Perhaps they became susceptible to infections, especially if   lancing was performed without antisepsis.  Another explanation of teething as a cause of death is that infants were often weaned at the time of teething; perhaps they then died from drinking contaminated milk, leading to an infection, or from malnutrition if watered-down milk was given.

Tetanus.  An infectious, often?fatal disease caused by a specific bacterium, Clostridium tetani, that enters the body through wounds; characterized by respiratory paralysis and tonic spasms and rigidity of the voluntary muscles, especially those of the neck and lower jaw.   Synonyms:  trismus, lockjaw.

Thrush.  A disease characterized by whitish spots and ulcers on the membranes of the mouth, tongue, and fauces caused by a parasitic fungus, Candida albicans.  Thrush usually affects sick, weak infants  and elderly individuals in poor health.  Now it is a common complication from excessive use of broad-spectrum antibiotics or cortisone treatment.  Synonyms:  aphthae, sore mouth, aphthous   stomatitis.

Trismus nascentium or neonatorum.  A form of tetanus seen only in infants, almost invariably in the first five days of life, probably  due to infection of the umbilical stump.

Typhoid fever. An infectious, often fatal, febrile disease, usually occurring in the summer months; characterized by intestinal inflammation and ulceration caused by the bacterium Salmonella typhi, which is usually introduced by food or drink.  Symptoms include prolonged hectic fever, malaise, transient characteristic skin rash (rose spots), abdominal pain, enlarged spleen, slowness of heart rate,   delirium, and low white?blood cell count.  The name came from the disease's similarity to typhus (see below).  Synonym:  enteric fever.

Typhus.  An acute, infectious disease caused by several micro-organism species of Rickettsia (transmitted by lice and fleas) and characterized by acute prostration, high fever, depression, delirium, headache, and a peculiar eruption of reddish spots on the body.  The epidemic or classic form is louse borne; the endemic or murine is flea borne.  Synonyms:  typhus fever, malignant fever (in the 1850s), jail fever, hospital fever, ship fever, putrid fever, brain fever, bilious   fever, spotted fever, petechial fever, camp fever.
 

V

Virus.  An ultramicroscopic, metabolically inert infectious agent that replicates only within the cells of living hosts, mainly bacteria, plants, and animals.  In the early 1800s virus meant poison, venom, or contagion.
 

Y

Yellow fever.  An acute, often?fatal, infectious febrile disease of warm  climates; caused by a virus transmitted by mosquitoes, especially   Aledes aegypti, and characterized by liver damage and jaundice, fever,  and protein in the urine.  In 1900 Walter Reed and others in Panama found that mosquitoes transmit the disease.  Clinicians in. the late nineteenth century recognized "specific yellow fever" as being different from "malarious yellow fever."  The latter supposedly was a form of malaria with liver involvement but without urine involvement.
 

  William Cullen, First Lines of the Practice of Physic with Practical and Explanatory Notes by John Rotheram (New York:  Evert Duyckinck, 1801); Robert Hooper, Lexicon?Medicum or Medical Dictionary (New York:  J. & J. Harper, 1826); Marshall Hail, The Principles of Diagnosis (New York: D. Appleton & Co., 1835); Robley Dunglison, A Dictionary of Medical Science, Containing a Concise Account of the Various Subjects and Terms (Philadelphia:  Lea and Blanchard, 1844); Richard D. Hoblyn, A Dictionary of Terms Used in Medicine and the Collateral Sciences (Philadelphia:  Henry C. Lea, 1865); William Aitken, The Science and Practice of Medicine, 2 vols.  (Philadelphia:  Lindsay & Blakiston,
1872); Richard Quain, ed., A Dictionary of Medicine (New York:  D. Appleton and Company, 1883); Austin Flint, A Treatise on the Principles  and Practice of Medicine (Philadelphia:  Henry C. Lea's Son & Co., 1884); George M. Gould, An Illustrated Dictionary of Medicine, Biology, and Allied Sciences (Philadelphia:  P. Blakiston's Son & Co., 1901); Glentworth Reeve Butler, The Diagnostics of Internal Medicine (New York and London:  D. Appleton and Company, 1903); The Random House Dictionary of the English Language, 2d ed., unabridged (New York:  Random House, 1987); Dorland's Illustrated Medical Dictionary (Philadelphia:  W.B. Saunders Co., 1988).

From the article "Disease and Death in the Nineteenth Century:  A Genealogical Perspective", by James Byars Carter, M.D. Exerpted from a complete article on the subject from The National Genealogical Society Quarterly, Vol. 76, (Dec 1988) pp 289?301.
 

  William Cullen, First Lines of the Practice of Physic with Practical and Explanatory Notes by John Rotheram (New York:  Evert Duyckinck, 1801 ); Robert Hooper, Lexicon?Medicum or Medical Dictionary (New York:  J. & J. Harper, 1826); Marshall Hail, The Principles of Diagnosis (New York:
D. Appleton & Co., 1835); Robley Dunglison, A Dictionary of Medical Science, Containing a Concise Account of the Various Subjects and Terms (Philadelphia:  Lea and Blanchard, 1844); Richard D. Hoblyn, A Dictionary of Terms Used in Medicine and the Collateral Sciences (Philadelphia:  Henry C. Lea, 1865); William Aitken, The Science and Practice of Medicine, 2 vols.  (Philadelphia:  Lindsay & Blakiston, 1872); Richard Quain, ed., A Dictionary of Medicine (New York:  D. Appleton and Company, 1883); Austin Flint, A Treatise on the Principles  and Practice of Medicine (Philadelphia:  Henry C. Lea's Son & Co., 1884); George M. Gould, An Illustrated Dictionary of Medicine, Biology, and Allied Sciences (Philadelphia:  P. Blakiston's Son & Co., 1901); Glentworth Reeve Butler, The Diagnostics of Internal Medicine (New York and London:  D. Appleton and Company, 1903); The Random House Dictionary of the English Language, 2d ed., unabridged (New York:  Random House, 1987); Dorland's Illustrated Medical Dictionary (Philadelphia:  W.B. Saunders Co., 1988).

  From the article "Disease and Death in the Nineteenth Century:  A Genealogical Perspective", by James Byars Carter, M.D. Exerpted from a complete article on the subject from The National Genealogical Society Quarterly, Vol. 76, (Dec 1988) pp 289?301.