varieties. Indeed many physicians inform us that they rarely meet with the typhoid form at all; whilst in the periodic varieties, they may have had an extensive practice, and when they do meet with it, it is during the winter season, or at a distance from rivers or other malarial sources. The first variety does not seem to be limited at all by the season, prevailing winter or summer, and is common alike on hills and in valleys. Localities apparently most healthy, often become the scat of this fever.

For upwards of twenty years, we have had frequent opportunities of meeting with it, and observing its phases. Patients generally complain for days, or sometimes for weeks, before the attack, of loss of appetite, headache, listlessness and dullness. Sometimes these symptoms steal on gradually, until the patient goes to bed without any marked chill or fever, or much increase of pulse, or other symptoms which attend the stadium prodromorum of the other fevers. There is merely an increased indisposition, gradually developed, some excitement of pulse, the secretions failing almost unobserved, so that it is difficult to fix any precise period of accession. The appetite and other functions seem to fail pari passu with the gradual increment of fever. When these premonitory symptoms are early attended to, the danger is pretty easily averted. A purge or two of calomel, and oil, with light diet and rest; or a few powders, daily, of ipecac. and calomel restore the functions. But when neg. lected until fever is fully developed the issue is often serious. During the progress there is accelerated pulse from day to day, with very little diurnal remission; towards morning there is generally an alieviation, but not a marked remission of symptoms. The pulse may diminish its number some 5 or 10 beats per minute. Pains in the head and back (especially the latter, which never fails to be present,) are for some days all that is complained of. The heat is but slightly increased, and the sudorous discharge diminished but little. The tongue, too, alters but slowly: at first clammy, then white, next brown or black, then all secretion for a time suspended, and nothing but a fiery redness in the middle, and as clean as if scalded and scraped-dry, chapped and tremulous. Then follows colliquative stools, incoherence of thought, and without a change, the patient is lost. In others, it advances with a fiercer step, yet rarely without predisposing illness, shorter but more impressive, before being seized with rigors. Pains in the back and head become almost excruciating; pulse sometimes corded; hot skin, sometimes perspiring, but which

soon declines into dryness, hard to be overcome. In this variety, pleuritis is a frequent concomitant, or pneumonia, or some other inflammation, which confuses the symptoms, and urges the adoption of active depletion. Bleeding in these cases at the earliest advice after the chill is over, is the hinge upon which reasonable expectation will turn. We bleed in an erect position, if syncope is difficult to effect, to the extent of 16, or 20, or 30 ounces. Then a full dose of calomel, say 20 or 30 grains, followed by 2 gr. doses in continuation with half a gr. ipecac. every two hours, until the bowels act freely. If in eight or ten hours this should not take place, then some other active purgative may be used, with clysters.

After venesection, we give immediate attention to the spinal pain, adopting the view that the nervous system is first in the circle of morbid action, and the cord, the great trunk which supplies its important parts with sensation and motion, cannot suffer long without bad consequences, not only to the nervous system in general, but to all the dependent organs supplied by its branches. It is accordingly examined, fomented with hot mustard water, or poulticed with mustard, or cupped and scarrified. Nor will this in the least interfere with or retard internal administrations, but rather favor their action. In all cases too, it is of early consideration with us, to equalize both circulation and temperature. Hot mustard pediluvia are excellent baths for the feet-in it they may be placed for twenty or thirty minutes, to be repeated pro re nata. The covering will answer the rest of the indication. Cold water is freely admitted, but only a mouthful or two at a time. The nauseating results of the calomel and ipecac. kept up through the whole day and night, are greatly beneficial. This course, if early pursued, will in a few days greatly mitigate the symptoms, which may induce the use of quinine.

If, however, these have been neglected, the prospect of success is greatly lessened. After the lapse of two or three days, we have rarely witnessed any beneficial results from bleeding; or if tempora. ry advantage is gained, yet there is great danger of an earlier collapse. Abdominal tenderness on pressure, rarely present at the beginning, is a pretty constant symptom after it has advanced but a few days; and it is one of the most difficult to meet of all the attend. ing symptoms. Whatever is the cause of this determination, whether a congestion of the vena portarum and branches, or a more idiopathic. like form of inflammation be established, and the lesion of the glands of Peyer and Brunner the centre of that action, or whatever other

theory may be adopted, of one thing we feel satisfied that the main hope of cutting off the disease at once, or of arresting its violence, depends upon the vigorous application of active anti-inflammatory treatment during the first day or two. If the period has passed unimproved, cupping and scarrifying may be tried; yet we acknowl edge they have not answered our expectations. Active purging, especially if drastic, seems to aggravate the symptoms: the pulse quickens and abdominal tenderness increases. Opiates, and ipecac., and calomel, and blisters, and demulcents answer a better purpose of defence. The blisters should be stripped as much as possible of the cuticle and converted into suppurative surfaces, and if ordinary appli. cations will not prevent healing, new blisters may be raised, and the surfaces washed with a decoction of phytolacca decandra or poke root.

We never fail also on a remission, however imperfect, to use the quinine, in doses of one and a half or two or more grains every two hours. When the case is alarming, we have given 5, 10, and even 30 grains at once. The opinion that acids, when in an uncombined state, almost always exercise an irritating influence on inflamed mucous membrane, have induced us to adopt the disulphate, or the common article, without the acid, because, in making the addition, it is rarely found without an excess of the latter, and it has, moreover, appeared to rest easier on the stomach in substance, than when it has been given in solution. We have used it freely in both conditions, and in many cases with marked advantage, but in many others we are bound to declare our total disappointment. In intermittents and remittents, generally, we can attest its utility. We however have met with cases of a synochal variety, where there were chills amounting to severe rigors and shakes, like those of intermittents, occurring irregularly for days, in which the quinine was administered very freely, even until deafness was produced, and dimness of vision, but without arresting the recurrence of the symptoms, and the patients sank in a few days into a fatal collapse. Some cases of apparent rigors seem to be unattended with the sensation of cold at all, and are therefore more properly belonging to neurotic phenomena, to which quinine does not appear to be so applicable as opiates or sedatives. Mercurial action, when mildly induced, has rarely failed of being a good omen; yet there is so much apprehension of intestinal irritation in protracted cases from a continued use of calomel, in any combination, sufficient to overcome febrile lesions, that it has been used with caution: even necessary evacuations are sometimes haz

ardous, superinducing irritation of the bowels, if not fatal diarrhoea. Too often, we feel compelled to adopt the defensive rather than offensive plan of treatment, and instead of jugulating the disease, to husband the resources of nature whilst we fulfil obvious indications, until the force of the disease is exhausted. As the result of our own experience we must say, that however strong the hope of quinine has been in this form of fever, it has not proved an antidote in our hands, but like calomel, ipecac., opium, the lancet, and many other useful agents, it is only the auxiliary. In these views, we find others, in whose experience great confidence may be placed, strongly coinciding. From answers to interrogatories on these points, we take the liberty of quoting from a few out of the many agreeing substantially in the same things.

The first is from Wm. N. Vance, M. D., of Kingsport, in the vicinity of Holstein river, and in a locality where intermittents and remittents often prevail. He says: "My experience in typhoid fevers, so called, has been quite limited. I have had some cases of that class of fevers, in the treatment of which I have been induced, by inviting circumstances, to try quinine; but I have never been satisfied with its effects. I have no faith in quinine as a febrifuge, except in fevers that observe well defined periodical paroxysms, and are at the same time unattended with high inflammatory symptoms. These are conditions scarcely ever found in what is called Continued fever. You know that owing to some hidden or mysterious influence, ALL forms of fever, whether idiopathic or symptomatic, observe more or less periods of exacerbation and remission. I have in some instances imagined the paroxysms well enough defined to use the antiperiodic, but was soon taught by bad results, that Medicine was not an exact science. If bad results were not the direct consequence, I have at any rate observed no good to grow from it. The reason why it has done no good in these cases may be that there was inflammation. If typhus or typhoid is an essential fever, we will, in all cases, I believe, during the progress of disease, meet with secondary lesions which add to the intensity of the symptoms, and aid in preserving the continued form of the disease. Or the reason it has done no good in my hands may be, that I have not given doses sufficiently large. I have had no experience in storming diseases by the heroic doses of quinine used by some of our Southern brethren. The shock produced by these doses might, in some cases be revulsive, but in many, fatal. So far would I be from using large doses of quinine in typhoid fever,

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that (if I could put faith in the motto of Hannemann—' Similia similibus curantur,') I would consider infinitesimal doses the very remedy. Pariera, in his Materia Medica, says, large doses of disulphate of quinine, produces three classes of effects, viz: 1st, Gastroenteritic irritation; 2d, Excitement of the vascular system, and 3d, Disorder of the cerebro spinal functions.' Almost an artificial Typhoid Fever!-an array of morbid phenomena that embraces all the prominent points in that disease. Whilst treating a case of remittent fever last fall, in company with Dr. we had some conversation on the use of quinine in the treatment of fever. His own experience was unfavorable to the use of this article as a therapeutic agent in the treatment of fevers of a continued form. He informed me that those who uniformly gave it were particularly unfortunate in that branch of practice. * * * ** With regard to the proportion of typhoid fever to other fevers, I do not know that I can give you any satisfactory information: it certainly must vary very much. A physician practicing in a malarious district must meet with a very small proportion of cases of typhoid fever. In my practice, the proportion of typhoid to intermittent and remittent would not amount to so much as one in twenty. I have no particular plan of treatment for this disease. My object is to avoid danger in whatever direction it may come looking at the different modes of dying as the great landmarks to guide me in my pathway."

The next I shall quote is a letter from M. R. May, M. D., residing at Athens, in the lower section of E. Tennessee. Athens is situated in the interior, some twenty miles perhaps from the river, in a dry, rolling country.

He writes" The fevers incident to our locality are of the typhoid tendency in fact, the disease called typhoid, has prevailed extensively during every season of the year, though principally in the summer and fall. I dont consider that it differs from the common continued fever, so far as its pathology is concerned; neither do I think that the intermittent and remittent fevers differ pathologically from continued."

He then speaks of the views of different authors on the pathology of fevers, and believes them similar. He says, "I also consider intermittents and remittents and typhoid, to be similar in pathology, from the fact of their often running into each other. I am at this time attending a case which was purely typhoid, 'ab initio,' which termin. ated in intermittent. If typhoid fever is dependent upon dothinenteri