whatever may be the complication or symptoms, the specific agent by which the system is depressed, after changing the condition of the blood, selects the glands of Peyer as the point from which its influence is communicated to the various organs and tissues, either directly through the circulation, or by reflex

action.

I do not wish to be understood as saying, that there are no cases of inflammation of the brain and its meninges ever found in typhoid fever; for there are exceptions to all general rules. But, in this disease, depression of the functions is the rule, and inflammation is the exception. Aside from the evidence furnished by post mortems, we may reason from a therapeutical point of view to prove this proposition.

The books are unanimous in condemning the use of opium in cerebral meningitis. They declare that it is not only contraindicated, but is positively injurious. But, on the other hand, every practitioner of medicine is aware of the happy effects of two or three grains of opium, in coma-vigil and typho-mania, of the typho-cerebral type of typhoid fever. So, then, the cerebral symptoms of this disease are not due to inflammation, or, if they are, then opium is the remedy par excellence for meningitis. But I do not see that there is anything to be gained by discussing this subject; for it is evident that the typhoid poison is capable of so depressing the nervous centres as to arrest the organic functions, and destroy life as surely as if inflammation had existed.

According to my observation, the inflammatory or non-inflammatory character of the cerebral symptoms, in typhoid fever, may be established by the thermometer. In this disease, the temperature varies in accordance with the degree of activity of the typhoid poison. There is always a difference of from 1° to 2° F., between the evening and morning temperatures; and this difference is always observed, whether the evening temperature is rising or falling. The temperature gradually rises in the evening and falls in the morning, until the former reaches 104°, and the latter 103°. When the temperature has reached these points, which is from the third to the sixth day, there is

a decrease, and it often falls as low as 99.5°, in the morning, and 100°, in the evening. This fluctuation continues for a longer or shorter period, when the temperature may again go up, until it reaches 105°, in the evening, and 103° in the morning. Thus the fluctuations take place from time to time, and the oscillations of temperature, between the evening and morning, continue with the same degree of regularity, until the beginning of the stage of convalescence, when the difference of oscillation may reach from 3° to 5°. But, on the other hand, in local inflammations, there is a gradual rise of the temperature, until the inflammation has reached its acme. And as the inflammation begins to decline, the temperature falls rapidly, until the standard of health is again reached.

The following are notes of a well-marked case of typhoid fever, of the typho-cerebral type. John Riccius, aged eight years, nervous temperament, had never been sick before; was troubled with headache, constipation, loss of appetite, sleeplessness, and general languor, from March 4th until the 10th, when he was confined to bed, with an aggravation of all the symptoms just mentioned. At 7 P.M., his countenance was expressive of pain and nervous excitement, with pain and tympanitis of the abdomen, and gurgling in the right ileo-cæcal region; stools thin and watery; skin was hot and dry; tongue covered with a brown fur; temperature 104.5° Farh. The temperature was first taken on the sixth day of the disease, and on each subsequent day of its progress, as shown by annexed table:

It will be observed, that on the 10th, the thermometer showed a rise of temperature, in the evening, to 104.5°; from the 10th to the 14th, the temperature had a downward tendency, until it fell to 99.5°. It oscillated until the 16th, when it rose to 104.5°, in the evening, and fell again to 101°, on the morning of the 17th, and rose again to 105°, in the evening of the same day. From this time until the 24th, the evening and morning temperature oscillated between 105° and 101°, when it fell to 99°, but arose again to 103.5°, in the evening. Thus the fluctuations continued until the eighth day of April, when the temperature fell to the normal standard, and the patient gradually recovered.

The reason that there is not so great a lesion of the ilium, in the typho-cerebral type of typhoid fever as there is in the typho-enteric is, because the force of the disease is called from the bowel to some distant organ. And there it may exert such an influence over the organic functions, as to increase susceptibility, destroy vital affinity of the parts, and produce death, by depression of the vital powers. A somewhat common and very dangerous complication is called

TYPHO-GASTRIC.

Soon after the characteristic symptoms of typhoid fever have been developed, the patient complains of nausea and vomiting, and of a load and pressure in the epigastrium. When vomiting occurs, it is only an ejection of the fluids that have been taken into the stomach. The fluids that are thrown up are sometimes of a yellowish cast, owing to regurgitation of bile. The pulse is quick and full; the skin is dry and hot; the tongue is covered with a dirty-white fur, and is a little brown in the centre. This form of typhoid fever is the most dangerous; and it may be mistaken for gastritis. It frequently destroys life in a few days. Owing to the fact that there is such a strong impression made upon the stomach, the bowels are not so loose as they are in the other varieties; and thus we may overlook the intestinal symptoms. If, however, they be examined carefully, the tenderness may be detected near the iliocæcal valve.

Another variety of typhoid fever often occurs in certain latitudes during the winter and spring, which has been named

TYPHO-PNEUMONITIS.

I have placed typhoid-pneumonia in the classification of continued fevers, because the idiopathic fever precedes the inflammation of the lungs; and the pneumonia is symptomatic, and, therefore, secondary to, and a complication of, typhoid fever. Whereas, in pneumonia proper, we may have a typhoid condition supervening the disease of the lungs; therefore one is the result or consequence of an idiopathic fever, and the other the effect of a primary local lesion.