entery, in this section, does not appear to be so great as in some other places.

The diseases most prevalent, in the elevated portions, are of an inflammatory character; chiefly affecting the respiratory function and organism. They are seen in every form, from simple congestion of the nasal membrane, to complete consolidation of the lungs; sometimes occurring singly, and at other times, taking on the form of an epidemic.

When diseases of this character are found to affect many persons at the same time, by closely observing their symptoms, it will often be found, that the fever accompanying them, has a periodic tendency, more or less marked. This is especially the case in bronchial affections, and indicates, as I think, a feeble action of the malarial poison, which not in amount sufficient to produce intermittent or remittent fever, has expended its force in modifying the existing epidemic.

I have come to this conclusion, from observing the curative power of quinine in their treatment. After having used a variety of other remedies, to no purpose, a few grains of this potent medicine has, as if by magic, restored the patient to health.

And, there is no doubt, that the severer forms of pulmonic inflammation are modified in the same way, and similar results will follow the judicious use of this remedy.

In such cases, the physician who frees himself from the notion, that quinine being a stimulant, must increase congestion, and heighten inflammation; and who, after carefully observing the manner of the disease, combined in due proportion, some mercurial with quinine, will effect more cures than those who rely solely on vomits, purges, and the lancet.

The extensive prevalence of catarrhal fever over large districts of country, is, no doubt, to be attributed to the presence in the air, of some subtile poison, which has, as yet, eluded the observation of men of science. It does not seem to be dependent upon any known atmospheric conditions, whether of weight, temperature, or moisture; nor upon the amount of ammonia or carbonic acid gas, found in a state of mixture with it. Its varying electrical states have not been sufficiently studied hitherto, in reference to this matter, to determine whether they are influential or not; though it does not seem unreasonable to infer, that they may be, when it is remembered how powerful are the effects of electricity, in a concentrated form, and under favorable circumstances.

Under the name of influenza, this complaint often prevails to a very great extent, bringing under.its influence almost every person in districts where it makes its appearance. The general tendency is towards recovery; running a course of from one to six weeks, of more or less severity; and resisting often the most orthodox plans of treatment, as well as the host of domestic remedies, which, as is stated, were never known to fail before. Sometimes the fever takes on a bad character, especially where from natural weakness, or previous disease, the power of resistance is impaired.

Such cases may prove fatal, and require the best judgment and skill of the physician in their treatment.

In my own practice, after having tried a variety of medicines, I have found excellent results to follow the free use of a decoction of flaxseed in good cider, to be taken in such quantities as may be agreeable to the patient. The demulcent property of this drink is, no doubt, of good effect; but to the acid of the cider, freed, as it has been by boiling, from a part of its stimulating ingredient, and retaining only its sugar and acid, must be attributed the chief value.

Probably an equal number of cases will be found to occur in high and low situations; but of greater severity and more difficult to manage in the former than in the latter; for in accordance with a fact alluded to before in malarial districts, this complaint, when assuming a violent aspect, generally takes on a periodic form, sometimes obscure and at other times well marked. The proper remedy here is quinine, which properly given will in most cases effect a cure. It seems as if the malarial poison had smothered out the prime disease, and left the physician only itself to deal with.

Pneumonia is far more frequent in the upper than in the lower portion of this district; but it is at the same time more manageable; for while the grade of the inflammation is more intense, there are fewer complications, and on this account more submission to proper treatment. In this unmixed form, as long as any air can find access to the inflamed part, although there may be a considerable amount of fibrinous deposit on the interior surfaces of the air-cells-bloodletting, pushed to such an extent as that the pulse shall show an enfeebled action of the heart, will in most cases put a stop to this disease. In the use of this remedy it is important that the stage of the disease be accurately determined; for it becomes of doubtful efficacy when consolidation has taken place; and this more especially when a large part of one or both lungs is

its seat. It often happens that the patient is walking about, and unaware of his peril during the first stage; and the physician is not summoned until the time has passed when the lancet could have been used with success. His resort then must be to mercury, which will rarely disappoint him, aided by blisters, opiates, and such other means as the state of the case may require. If there be a malarial complication which in general is easily detected by faint febrile remissions, quinine must be added to the mercury to reduce the disease to its simple form, and bring it within reach of the remedies denoted against the inflammation. Pneumonia biliosa is the name given to this complication. It is sometimes extremely prevalent, chiefly in the low districts; occurring oftenest in the fall, and beginning of winter. This is a very bad form of disease, and is frequently fatal, from the debilitated state of those in whom it is seen; its subjects being persons who have recently had malarial fever, or who have been weakened by intemperance or other causes. There are but few cases in which bloodletting can be used. From the very onset of the disease, a want of vital energy is apparent, and the little that remains must be husbanded, while the disease is combated with blisters, mercurials and quinine.

It has been long noticed that tubercular deposits in the lungs, are of less frequent occurrence in malarial districts than elsewhere; and it moreover rarely happens that persons, laboring under phthisis, especially after hectic fever has declared itself, indicating a softened state of the tubercles, are brought under malarial influence. It is impossible to account for these facts in a rational way. Their truth, however, being well established, physicians have inferred an antagonism between the two morbific causes. And in the hope that the tubercular element, might in some inscrutable way, be destroyed by malaria, have been in the habit of sending their consumptive patients into malarial districts; but with the almost universal result of adding to the discomfort of the sufferer, and often, indeed, of hastening his death; not from any bad effect of the climate, but by depriving him of the comforts of home, and the society of those who love him, which, in the rapidly waning hours of his life, are his only stay.

From observations made upon the frequency of the occurrence of consumption in high and low districts of country, I have concluded that there are one-third more in the former than in the latter; and think many persons in whom the predisposition to this is very strong, might altogether escape, by removing to a malarial

district, before any of the physical signs of phthisis were manifest.

As a means of relief from the distressing irritation consequent upon this disease, it will be found that a small blister, applied as near to the axilla of the affected side as it can be, without impairing the motions of the arm, and frequently removed, is often very serviceable. And unguents, composed of anodyne ingredients, seem to have a more composing effect, when applied in the axillæ, than when rubbed on the anterior part of the chest.

Rheumatism is another disease common to this region. I have never known it to assume a strictly epidemic character, though it is much more frequent in some seasons than others. The acute variety is found oftener in the elevated territory; while the chronic is more frequently seen in the lower districts. If it be entitled at all to the character of an epidemic, it is under the chronic form, for it is not uncommon to see malarial epidemics passing off at the close of autumn in the shape of chronic rheumatism.

Acute rheumatism owes its origin to defective nutrition, brought about by errors of diet and improper exposure to great atmospheric changes.

What is sometimes called rheumatism does now and then seem to take on a periodic form, or it may be alternate with an intermittent. And it is not uncommon to see an intermittent, suddenly and without apparent cause, change itself into a periodic pain; as in hemicrania. But this is not rheumatism; it is an intermittent with an attempt at concealment. A few grains of quinine, or a little of Fowler's solution, will at once cure it. The same remedies, however, will not cure genuine chronic rheumatism; and, indeed, I do not know what will. The faculty have advised "patience and flannel," which are no doubt very good; while a celebrated divine has spoken highly of "sulphur and supplication." It would not be amiss in the treatment to try both plans.

Scarlet fever has prevailed to considerable extent for the last few years. It is generally first seen in the fall of the year, continuing during the winter, and until late in the spring. Very hot weather in the region under consideration checks its progress; while further north, though lessened in frequency and violence, cases of it are found occurring at all seasons of the year. In higher latitudes too, when assuming the epidemic form, it attacks a much greater number, leaving, indeed, but few of the younger portion of the population, who have never had the disease, unaffected. Probably

not more than one fourth of all the children under twelve years of age here, are attacked by scarlet fever, although living within the range of the disease, so far as atmospheric causes are concerned. And I have seen children of the same family, some taking it and others remaining free. It may be, however, that they came under its influence, but so slightly, as not to interfere with their general health to an extent to be noticed. In the more elevated portions. of the country, the disease assumes a worse form, and more fatal cases occur, than in those of a lower level.

That this disease is contagious there can be no doubt; but its law of contagion is subject to more exceptions than any other disease of a like character; so much so, indeed, that some observers have denied to it any specific contagion at all. And certainly some facts in my own experience would seem to tend to this conclusion. But the mass of evidence is on the other side. It does not seem difficult to account for the frequent exemption from attack in cases of undoubted exposure to its influence. There is no disease whose variations of intensity equal those of scarlet fever. There shall be a family of five children, all of whom are exposed to the contagious influence at the same time, and, as nearly as we can judge, under the same bodily conditions; one will have the disease and die, another barely escape with life, a third be confined to bed only a day or two, a fourth with just enough of the symptoms to mark the disease, and the fifth show no signs of it whatever. This state of things occurred in my practice some years ago; and although scarlet fever has occurred in the neighborhood since, and the little boy who escaped the disease was exposed to its influence, yet he was not affected by it, and the probability is he never will have it. The explanation that suggests itself is, that while the morbific influence was not powerful enough to cause, in his case, a departure from health, it had yet sufficient force to insure him against its attacks in future; and an inference that those persons who, though exposed to the contagion of scarlet fever, do not take it, have, at some former period of their lives, been secured against it in the same way.

The poison of this terrible disease concentrates itself upon the mucous system of vessels, and they fall at once into a state of torpor, almost indeed of paralysis. The capillaries of those mucous surfaces which we can see are gorged with blood, and its passage through them very languid, as is shown by pressure on the skin, the tongue, and the fauces. The function of these surfaces being depurative, a failure in their action involves such an accumulation