was directed, to be applied after carefully syringing the ears out with clean tepid water three times a day.

This treatment was continued with the use of a mild astringent gargle, (the throat being slightly inflamed) for three days, when my patient left the city for his residence, some eighty miles distant, in New Jersey, to return at the end of a week or ten days.

On the 31st of August he again called upon me, and I found the blistered surface healed. The discharge from the left ear had ceased, and the internal surface was dry and shining. The hearing distance had increased to four inches.

The discharge from the right ear had diminished, but the process of destruction was evidently still going on. The hearing distance had however improved to about five inches. The blisters were re-applied with directions to add a small quantity of the ceratum cantharidum to the ordinary dressings, in order to keep up the irritation and discharge. The strength of the lotion was increased to six grains of the acetate of lead to the ounce, and the fluid extract of sarsaparilla, as prepared by Maris & Co., of this city, was directed to be taken in teaspoonful doses twice a day. The gargle to be continued-exercise in moderation to be taken, and to avoid coffee, and most of the unnecessary stimulants. On the 2d of September he left for his home, the hearing distance having increased to six inches in the left, and seven inches in the right ear. The discharge from the right ear almost nothing.

Sept. 17th. The hearing continues in the improved condition; the discharge from right ear still to a small extent. The sulphate of copper in solution was directed as a lotion. The etherial vapour was introduced a few times through the Eustachian tubes, with some small improvement in the sensibility of the nerves of audition. The ears were directed to be kept warm, and protected from dust and changes of temperature, by the use of wool in the auditory canal.

On the 19th patient left the city for his home, with the hearing improved in the right ear to ten inches, the discharge having entirely ceased; and in his left, to something more. One year nearly has passed away and the improvement continues. Other cases might be taken from our case-book, but we did not design to make a long article; "sapienti verbum sat."

Practical Observations on Ship Fever as it prevailed in Philadelphia and its environs, in the months of June, July, and August, 1847. By LAURENCE TURNBULL, M. D.

This disease prevails at the present time to some extent as an epidemic in our city and suburbs. During the last three months, there have been over three hundred cases admitted into the

almshouse, and a corresponding number under the care of physicians resident in the city. Having had a number of cases in charge, I have taken this method of making known my views of its nature and treatment, hoping my endeavors may add something to the general stock of knowledge concerning it.

The first great cause of this fever may be traced to the starving state of the population of Ireland; with the subsequent crowded condition of our immigrant ships, without a proper attention to cleanliness and ventilation on the part of their commanders; thus causing the generation of an animal effluvium, which, contaminating the surrounding atmosphere, is received into the lungs, thence proceeding into the circulation. extreme series of organic capillaries being thus irritated, occasions a subversion of the existing mode of action, through which the different secretions and functions are diminished, increased, or modified.

The

This disease attacks all ages, from the infant to the old man, and not the poor immigrant only, but the residents of our city, passing by means of this contagious effluvium into the lungs of all constantly exposed to its baneful influence. There cannot be a doubt concerning its contagious nature, as nine of the most severe cases out of twenty-one, in my own practice, were those residing in the same houses with the sick, none of them having been on board ship, but citizens for some time.

The period which elapses before the disease shows itself averages from one to two weeks, but in most cases it makes its appearance in a few days after leaving the vessel.

Nearly every ship which enters our port brings a greater or less number of invalids, some having suffered for twenty-six and twentyeight days, without proper nourishment or medical attendance. In many instances, the number of passengers in the Liverpool packets to New York, has exceeded five hundred, and the regulations of those ships obliged them to leave their berths between the hours of three and four, A. M., for the purpose of cleansing them, so much water being used in this process as to leave them in a damp and unhealthy condition for many hours. The water for culinary purposes was not distributed until nine, so that the strong and active alone procured a meal before twelve or one, P. M. To insure personal cleanliness for those who were not so disposed, a barrel of water was provided and a portion of it poured over the poor creatures, who were not even fortified by proper food. It cannot therefore be a matter of astonishment that a number should be sick on the voyage, and a still larger number fit only for the hospital on their arrival, having had within the vessel all the elements to generate typhus fever. First, their crowded condition; secondly, their want of proper rest; thirdly, the want of proper nourishment; and

fourthly, the damp condition of their sleeping and eating apart

ments.

The authorities now remove the sick either into the Lazaretto or the fever hospital at Bush Hill, which was opened for the reception of patients on the ninth of July, under the charge of Drs. L. W. Knight and William Ashley; one hundred and eighty cases having been admitted from that time up to the eighteenth of August. Of that number thirteen have died, thirty have been discharged cured, and one hundred and thirty-seven remain under treatment.

Of the thirteen cases which terminated fatally, three were in a dying state when admitted, and three died of purpura hæmorrhagica, marasmus and phthisis pulmonalis, thus considerably reducing the number of deaths by fever, and showing that the mortality is small in comparison with the accounts received from Canada and New York.

The situation of the hospital is very favourable, being light, dry, and well ventilated. The only objection is the want of space, obliging them to crowd the wards, so that dysentery or diarrhœa occurring as a complication, it is apt to assume a malignant form.

The premonitory symptoms are as follows: Slight chill, skin hot and dry, nausea, and in some cases vomiting, muscular pains in the back and limbs, with intense pain in the frontal region, increasing from the first to the sixth day. Tongue of a whitish color over the surface, tip of bright red; pulse averaging from eightysix to one hundred and twenty, with bowels costive.

These symptoms continue for several days, when the skin becomes of a dusky red, the eyes are injected, tongue covered with a thick yellowish, brown, or black paste; teeth covered with sordes; acute pain over the epigastric region, with skin covered with a petechial eruption coming out from the sixth to the tenth day. Delirium now supervenes, with congestion of the lungs, brain or bronchial tubes, generally accompanied by deafness, with spasmodic twitchings of the muscles, and in some cases dysentery and profuse sweats, not of a critical nature.

These symptoms either increase or diminish towards the thirteenth or fourteenth day, or may terminate in death from the twentieth to the thirtieth day, the liability to relapse being very great in all

cases.

I have found the following symptoms favorable when occurring about the fourteenth or twenty-first day: tongue becoming moist, first at edges; slight salivation; pulse fuller and slower, with tongue not tremulous when protruded. Unfavorable symptoms: great muscular debility; decubitus, or gliding down to the bottom of the bed, picking at the clothes, or catching at imaginary objects.

Treatment. In the first stage a gentle aperient of oleum ricini or mild neutral salt. Second stage; to diminish the fever by freely

sponging the body with tepid water, with the free use of ice or neutral mixture. Thirdly; to subdue local inflammation by cups or leeches, and by applying cold by means of ice to the head, or blister to the nape of the neck, with small doses of hydrargyrum cum cretâ and pulvis rhei. Lastly; to give quinia sulphas in pills of one grain three times a day, with from f3iv. to f3vi. of port wine.

By following the above course of treatment, bearing in mind ventilation and cleanliness, with a simple farinaceous diet, out of twentyone cases I have lost but two, and regretted much that in both instances there was no opportunity for a post mortem examination. 385 Spruce street, Philadelphia.

BIBLIOGRAPHICAL NOTICES.

The South-Western Medical Advocate. Edited by JAMES CONQUEST CROSS, M. D., Professor of the Institutes of Medicine and Medical Jurisprudence in the Memphis Medical College, assisted by his colleagues. No. 1. Vol. 1, for July 1847. Memphis, Tennessee.

It has ever been our wont to herald every new labourer in the arduous, responsible, and, too often unrequited and thankless field of medical journalism; and with sincerity have we welcomed them when ushered into existence under the banner of chivalry and honour, even although they may have attached themselves to some particular school or clique, whose interests they professedly watched over. The number of the Journal-if so it may be called-before us, by its very title indicates that it is not free from such bias; nor do we object to it on this account. To be the organ of the profession in the south-western portion of this extensive country would be an enviable position for the editor; but we feel assured, that if the forthcoming numbers are to be judged of by the present, the high-minded and liberal practitioners of that region will eschew it, and deny that the unqualified and reckless assertions contained in it are participated in by any one of them. The advocacy of south-western medicine is, however, but an infinitesimal portion of its objects. The grand desideratum is "to establish a medium of communication be

tween the Memphis Medical College," [an institution established immediately after the editor left the Transylvania school]-" and the Medical Public of the south-west;" and a secondary-perhaps primary-object would seem to be, to enable the editor to rail against all who have in any manner interfered with his devious course, and especially against his former colleagues of the University of Transylvania, who, some time ago, published, under their own signatures, statements, which it would be difficult to believe were without foundation, and from which, unquestionably, it has not been an easy matter for the editor to exonerate himself. Of this controversy, notwithstanding the number of missives that have reached us, we have hitherto expressed no opinion. For the sake of the individual most deeply concerned, as well as of that of the profession to which he belongs, and of the respectable school of which all the controversialists had formed part, we were silent and we had hoped, that some discretion would have been exercised, and that if it had been deemed proper that such a discourse as the one that fills the first number of the "South-Western Medical Advocate" should be delivered, it most assuredly would never be published,—even although requested by a Board of Trustees, and by a medical-always indulgent— class.

The number before us is truly a "psychological phenomenon." It is wholly occupied with "An inaugural discourse on the policy of establishing a school of medicine in the city of Memphis, Tennessee." It is essentially the editor and the Memphis Medical School-Ego et rex meus !—A goodly portion treats of the editor; another portion of the Memphis Medical School; whilst no little space is devoted to the threadbare arguments on "sectional medicine," and to show, that a south-western physician must be educated in the south-west,--of course at Memphis, upon the same principle, we presume, as the old Joe Miller belief, that if a man be born in a stable he must necessarily be a horse;that northern schools are inadequate to teach southern students, -that northern pathology and therapeutics are not southern pathology and therapeutics;-and farther, that the respectable gentlemen who fill so well the different chairs in Louisville, and in Lexington,-where the editor himself taught so lately, and for which he was so long the energetic advocate,—are wholly unfit