It was thought remarkable that the form of continued fever which was most usually found in the great continental cities, in Paris, Berlin, Prague and Vienna, namely that with ulceration of the lymph-follicles of the intestine, should be but occasionally mixed with the old typhus in England, Ireland and Scotland in the very same years. But there was nothing to discredit the British observations, anatomical and clinical; and in 1836 Dr Lombard, of Geneva, having visited various cities in England, Scotland and Ireland bore witness to the matter of fact, strange as it was to him. Writing to Graves, of Dublin, on 16 June, 1836, he said: “Before I leave Ireland, allow me to express to you my great astonishment at what I have seen in this country respecting your continued fever;” and in a second letter, of 18 July, after his return to Geneva, he added, that in Liverpool, ulceration of the ileum in continued fever was “occasional,” that in Manchester he had been told it occurred “by no means always,” that in Birmingham the cases of fever were not many, but “always” with intestinal ulceration, and that in London “not a fourth part” of the cases of fever had the latter condition, and these mostly in autumn[383]. This was before the great epidemic of typhus had begun in the English towns. To the same non-epidemic period (1834) belongs the statement of Carrick, for Bristol, that fever was often observed to be infrequent or altogether absent in the most crowded and dirty parts of the city at times when there were a good many cases “in institutions and dwellings where cleanliness and free air are most carefully attended to,” and that ulceration of the bowel was the most common post-mortem appearance[384].