APPENDIX-Section on Practice of Medicine, etc. Suspicion being now aroused as to the essential nature of the case, the patient was promptly placed on ten grain doses of the sulphate of quinine, to be taken every four hours with mercurial and saline purgatives, the latter being indicated by the appearance of the tongue, and confined state of the bowels, which was due not altogether to the opium administered, since its physiological modifier had been exhibited both freely and simultaneously. The substitution of the quinine for the treatment previously pursued, like the fabled wand of the magician, broke the spell of the enchantment, which, by its subtle and potent influence, had held the patient with relentless grasp for three weeks, and had transformed a hopeful and contented disposition into one of melancholy and apprehension. At the end of four days from the administration of the first dose of quinine, the patient was virtually convalescent. During this period, no opiate was employed, nor any other medicine but quinine taken, save an occasional dose of neutral mixture, chiefly for its sudorific effect. Nevertheless, the irritation of the bladder did not return, and the close ot the week found the patient, although debilitated by the trying ordeal through which she had passed, enabled to resume her accustomed duties, which were continued up to March 18, with little, if any, trace of the vesical disease remaining. On two occasions since this date, when she had been on her feet longer than was prudent, a slight pressing sensation was felt in the locality of the original Malarial Irritation of the Bladder-Henry K. Leake, M. D., Dallas, Texas. tenesmus. This was promptly and permanently relieved by assuming the recumbent position for a short time, and employing a rectal suppository of morphia and extract of belladonna. On interrogating the patient, March 20, I learned that the urine was passed at normal intervals. Personal inspection showed it to be clear and presenting no evidence whatever of any former derangement of its physiological character. At the present writing, March 24, I am informed that the patient has had a slight chill since my last observation. The irritation of the bladder, however, has not relapsed. The sulphate of quinine is still exhibited in five grain doses, morning, noon and night, after meals, and the secretions are regulated by appropriate medication. The behavior of the malarial poison, when received into the organism, certainly presents one of the most curious and protean manifestations of disease, to which the human system is liable. If the latter, for a certain period of time, varying with the intensity of the poison, and the susceptibility of the individal, has been subjected to its modifying influence upon the hæmato poetic functions of organs, and upon the constitutional elements of the blood-cell itself, the results are clearly apparent, and are witnessed as the grosser manifestations of its operation, interesting to the practical physician, no less than the scientific pathologist who is satisfied only with a knowledge of the primordial causes of dis ease. APPENDIX—Section on Proctice of Medicine, etc. Tomasi-Crudeli, Marchiafava and Klebs, may supply the physician with the rationale of the almost unfailing specific, which he triumphantly employs. Nevertheless, in some cases of malarial empoisonment, his efforts will be limited to removing the immediate and remote effects of its ravages, which are well determined, by unmistakable signs, to be the consequence of its activities within the tissues and fluids of the body. The pathological picture, therefore, for the most part, in both acute and chronic forms of malarial disease, is so uniformly presented, and so well impressed in the average professional mind, as to afford little excuse for mistaking its details, or abolishing these by a few strokes of well directed and commonplace effort. It is the more protean and anomalous manifestations of the malarial poison, however, which are liable to confuse and decoy the physician into false positions of diagnosis and treatment. In my opinion, a prevailing and pernicious error it is. which encourages the unquestioning belief in an invariable periodicity of action, which will find expression in the clinical history of every form of genuine malarial impoisonment. That much evidence has accumulated going to show that many active disturbances of the system are due to the veiled presence of the malarial poison, wherein periodicity forms no part of the symptomatology, is not, in my judgment, sufficiently appreciated by the profession. Consequently, it might not prove an unprofitable enterprise to seek for other less palpable, Malarial Irritation of the Bladder-Henry K. Leake, M. D., Dallas, Texas. but fairly reliable, signs, perhaps, of its potentiality in the system than periodicity, and those gross alterations of function and structure which, as a rule, it does, but exceptionally, it does not, produce. In what directions we shall look for these additional signs, which may not exist at all, remains for the future to determine. If the above mentioned pathologists are correct in their assertions as to their discovery of a malarial germ in the plasma of the blood, or the recently published claims of another Italian investigator, who has described a minute organism ensconsed within the very precincts of the blood-cell itself, be confirmed, then we may reasonably hope to find other reliable evidences of the vital activities of the malarial parasite. Should such welcome discoveries be made, the physician would be materially assisted in the treatment of many a doubtful case of disease which now confronts him, more especially if practicing in an intensely malarious climate. Moreover, the invariable and hurtful system of quinine drugging, which is indulged by many physicians in all cases, lest the malarial element be the principal, or a subsidiary cause at work, would be happily avoided, both in the interest of the patient, who, exceptionally, it is true, may be gravely affected by it, and that of the physician, whose success in treatment, and, consequently, whose popularity would be increased; for, with the laity, he latter not seldom turns upon the fact that he does not give quinine for every case of disease with which he may be entrusted. Finally, "that glaring fraud of APPENDIX-Section on Practice of Medicine, etc. the nineteenth century," Homœopathy, would be shorn, quo ad hoc, of the strength it has obtained from a credulous public in return for the enticing consolation it offers in the shape of a defiant claim that disease, even malarial, may be successfully treated without invoking the terrifying reality of the hangman's knot, closely simulated by the arrest of a ten grain quinine capsule in a hyper-sensitive throat. For, unlike the pleasures of of the sense of sight, as disparaged by Mr. Addison, when compared with the pleasures of the imagination, the diagnosis of malaria would not suffer by being "more confined and straitened" in its operation on the mind and therapeutical activity of the physician, who, like imagination as well, in the Addisonian sense at least, would take a more comprehensive view of disease, and treat it accordingly. Then the false lights of Homœopathy would be effectually paled in proportion as we refined our diagnosis, our knowledge of the natural history of disease, and leavened our therapeutics with the established facts of a broad conservatism. I have, myself, searched in vain for some trustworthy sign, apart from those signs afforded by the experience of the past, for the detection of malaria in the system, more particularly with reference to accurately differentiating the continued types of fever, which have claimed a large share of my professional service. Denied, often, the pathognomic symptom of periodicity in this class of cases, and in many others, which have progressed for a more or less long period of time, without the mani |