take the cinchona and acid mixtnre, with 5 grains of the disulphate of quina, and half a drachm of the compound tincture of camphor, three times daily, and the hyoscyamus, and Dover's powder pills at night.

On the 17th of October, she stated that she had had the shivering every other day, though less severely than before. She had gained strength, and her cough had been less troublesome.

On the 21st, she said she had been too ill to attend on the 14th. During the week in which she continued to take the medicine, she had only one attack; but during the last week, being without medicine, she had two attacks, but they were less severe than before.

Case 3.-Ague occurring in the early stage of phthisis; the former disease cured, the latter still progressing:

James Tayler, aged twenty-five, a painter, residing at Rochester, was admitted an out-patient of the Victoria Park Hospital on the 6th of August, 1858. He stated that he had been declining in health and subject to cough and expectoration, and occasionally of blood, for the last three years. About two years after the commencement of his illness, and one year before he applied at the hospital, he had an attack of ague, which disease he contracted while working at Cliff in the marshes between the Thames and Medway. The aguish attacks were decided, and recurred every other day for four or five times, and slightly for a longer period, but they were ultimately stopped by medicine. He has not had any symptoms of ague since, but his health had rapidly given way. When he applied at the hospital he complained of a severe cough, which was attended by copious expectoration, especially in the morning: he was pale and thin. The tongue coated at each side, and the pulse quick. The whole of the left side of the chest expanded very imperfectly, and there was a distinct bruit de pot-felé heard on percussion beneath the left clavicle, with loud cavernous sounds and gurgling in that situation. He was directed to take the cinchona and acid mixture, with cod-liver oil three times daily, and a soap and opium pill every night. He was last seen on the 16th of December, and the phthisical symptoms were then advancing.

Case 4.-Signs of commencing consumption and aguish symptoms coincident; result not known:

Hannah Jones, aged fifty-two, a married woman, residing in Blackfriar's Road, applied as an out-patient at St. Thomas's Hospital, on the 6th of November, 1857. She stated that she had been ailing for nine months, suffering from cough and expectoration, and that four months before she had spat blood. She had a very malarious aspect, and complained of suffering from chills, commencing about ten o'clock every forenoon, and followed by heat, but without sweating. On examining the chest, the resonance on percussion was found to be deficient at the apex of the left lung, but there were no other marked signs of tuberculous deposit. She was directed to take quinine, and was relieved from the aguish symptoms, and ceased attending on the 27th of November. Her subsequent history is not known.

In addition to the cases which I have now related, and two to be reported hereafter, I have met with three other instances of the coëxistence

of consumptive symptoms and ague. One of these was that of a lady residing in the Isle of Sheppy, who, with slight evidences of consumption, had decided ague, which was removed by treatment. Another was the case of a young girl from Rochester, an out-patient at St. Thomas's Hospital, who had advanced consumption and decided ague, and died shortly after she was brought to me. The third was an out-patient at the Victoria Park Hospital, residing in Stepney, a middle-aged man, who presented the usual signs and symptoms of phthisis in the second stage, and had irregular aguish symptoms, which were relieved by treatment. Of the subsequent history of three of these cases, in which the pulmonary affection was in an early stage, I have no knowledge; but leaving them out of consideration, the others which I have reported are sufficient to show that phthisical patients may take ague, and that when that complication occurs the symptoms of consumption are greatly aggravated and its fatal result hastened.

It is, however, quite possible that though consumption may not grant immunity from attacks of ague, yet the occurrence of ague may prevent the subsequent development of consumption. My attention has only recently been directed to this inquiry, and it is not a large number of phthisical patients from aguish districts which come under my notice, but I have at present two patients who inform me that they have had attacks of ague before their phthisical symptoms occurred, and that they have continued to reside up to the present time in the districts in which they contracted the disease. The following cases, indeed, may be regarded as "crucial instances," in deciding the question of the antagonism of phthisis and ague, inasmuch as they not only afford examples of the coincidence of the two affections, but show that phthisis may develop itself in persons who have had previous attacks of ague, and who have continued constantly exposed to the malarious influence.

Case 5.-Ague occurring in the phthisical patient, who had previously had several attacks of ague. The former disease cured; the latter still in progress:

M. A. Heard, aged thirty, a married woman, residing at Aveley, near Purfleet, in Essex, applied as an out-patient at St. Thomas's Hospital, on the 23d of September, 1858. She stated that she had been ill for five months, suffering from cough and expectoration, and had occasionally spat small quantities of blood: her voice had been for some time hoarse, and she had lost much flesh, and was pale and thin. She also suffered from attacks of ague, which came on every other day at eleven A. M., with shivering, after which she became hot and sweated profusely. She said that she had had an attack of ague when ten years old, and while residing in the neighborhood of Rochford, which continued at intervals for fifteen months, and she had since had two or three other attacks, and she had resided all the time in different parts of Essex bordering on the marshes. On examining her chest, the resonance on percussion was found to be impaired, and there was loud cough resonance at each apex. She had been taking quinine and cod-liver oil, and the same remedies were continued. On the 21st of October, the aguish attacks had entirely ceased, and she was otherwise improved. Since this time she has

been admitted into the Victoria Park Hospital for Diseases of the Chest. She has had some recurrence of the aguish symptoms in the form of chills, coming on at a regular period. There is marked dulness on percussion, with bronchial respiration, and undue cough resonance at the right apex, and the resonance on percussion is impaired, and the respiration harsh, and the resonance with the cough increased at the left apex.

Case 6.-Phthisis and ague in a person who had previously had ague. The latter disease relieved, the former progressing:

William Cox, aged forty-six, a laborer, who had resided at Woolwich for the last twelve years, and had had ague six years before, applied as an out-patient at St. Thomas's Hospital in August last, and was admitted into Jacob's Ward, under my care, on the 2d of September, 1858. He stated that he had spat blood seven or eight years before, but had only been seriously ill for a year, and had been suffering from symptoms of irregular ague for nine weeks. When admitted, he complained of difficulty of breathing, cough, and expectoration: he was emaciated, the pulse was weak, and he had a very malarious aspect. Every other morning he became very chilly, and had violent retching, followed by heat and sweating, but he had no distinct rigors. On examining his chest, the resonance on percussion was found to be generally deficient at the upper parts, where also the cough resonance was very loud, and sonorous and mucous rhonchus were heard in all parts of the chest, and were especially marked in those situations. He was directed to take three grains of quinine and 3j of compound tincture of camphor in 3 iss of the cinchona and acid mixture three times daily, and wine and a nourishing diet were allowed. On the 11th, a blister was applied between the scapula, and an ipecacuan and squill pill was ordered to be given at night. On the 15th he was much better, the aguish symptoms had entirely disappeared, and he looked much less malarious, but he still had a severe cough and copious mucopurulent expectoration. There was some deficiency of the resonance on percussion at each apex, with falling in of the parietes there, and bronchial respiration and loud cough resonance, and these signs were the most marked on the right side. There was also some subcrepitant rhonchus heard low down in each dorsal region, but the respiration was generally free. The cod-liver oil was directed, in doses of two drachms, with the tonic and cough mixture, to be taken twice daily.

On the 22d he was not improving. He continued to lose flesh, and complained that he had taken fresh cold, and wished to be made an outpatient. This was done, but he has not since returned to the hospital.

The facts which I have now detailed conclusively show that neither does the existence of consumption prevent the occurrence of ague, nor the occurrence of ague preclude the subsequent development of consumption; but they do not prove that the supposed antagonism may not, in some degree, exist. For, on the one hand, phthisical patients, subjeeted to the influence of malaria, may take ague in less proportion than healthy persons similarly exposed; and, on the other hand, persons who have had ague may be less liable to consumption than those who have not had the disease. These objections I have no means of meeting, but when it is considered that, within a period of two years, five cases of the

coëxistence of the two diseases have fallen under my own notice, at one public institution, where the majority of phthisical patients do not come from malarious districts, the coincidence cannot be regarded as exceptional or rare.* I cannot, therefore, but conclude, that it is not probable any material antagonism exists between phthisis and intermittent fever. The facts do not, however, warrant the denial of the supposition altogether, and there are probably few popular ideas which have not some foundation in truth.

The correct inference would appear to be that the influence, if any, exerted on the prevalence of consumption by a malarious atmosphere or by ague, is far less important than that of various other causes which affect the development of that disease. The practical conclusion also to be arrived at is, that as phthisical patients may take ague, and as such complication materially aggravates the original disease, we should, in selecting residences for consumptive patients, avoid those situations which are marshy, or in which aguish affections are known to prevail.-British and Foreign Medico-Chirurgical Review for January, 1859.

During the two years in which these five cases occurred, I treated at St. Thomas's Hospital, among the in and out patients, 236 cases of ague, and at least 262 cases of phthisis The precise number of cases of the latter disease I cannot give, as some cases of phthisis are entered in the out-patients' book as "affections of the chest." I have also met with several other cases in which there was reason to suspect tendency to phthisis in aguish patients.

Bibliographical Notices and Reviews.

HINTS TO CRANIOGRAPHERS, upon the Importance and Feasibility of establishing some Uniform System by which the Collection and Promulgation of Craniological Statistics and the Exchange of Duplicate Crania may be promoted. By J. AITKEN MEIGS, M. D., Prof. Inst. Med. Philadelphia College of Medicine, etc., etc.

The object with which this little pamphlet was published, and which is stated on its title-page, is one which can be looked upon with indifference by no one who is interested in the advancement of science. For the purpose of increasing craniological knowledge, he suggests various expedients, the most important of which consists in the forming wellwritten catalogues of existing collections, with a view to the interchange of duplicates.

We transcribe the following paragraph as to the best mode of bringing the various societies and individuals engaged in these researches in rapport with one another:

"Again, it appears to me that the progress of craniography might be very much and very readily facilitated by some such plan or system of cooperation as the following. Let all those actually engaged or interested in the study, in any particular country, notify the secretary, or appropriate officer, of the most prominent and best known scientific institution in that country, of the existence and precise location of any collection of crania with which they may be acquainted, no matter how small or imperfect such a collection may be, stating carefully the name and address of the Society or individual owning the collection, the number of skulls contained, and the different races of men represented therein. Let the secretary or other officer receiving such communications cause them to be published from time to time in the printed journal, transactions, or proceedings of the Society. These being sent in exchange or otherwise to scientific associations and individuals in other countries, would thus become the vehicle for the transmission of this information to the craniographers of the latter places. In the United States, for example, the