vaso-motor nerves. The diarrhoea of intestinal typhoid, and its follicular deposits, seem to me to be well explained in this way. "13. An occurrence which I think is more frequent in malarious fever, but which Dr. Corrigan speaks of as not unfrequent in typhus, or rather as a sequela of typhus, of late years, is jaundice; the skin and urine being deeply tinged, though the flow of bile into the intestine goes on freely. In this case it may be presumed that the hepatic plexus is paralyzed, and the liver in the same state as the side of the head when the cervical sympathetic is divided. Bile is secreted in excess, and a secretion-flux takes place. This, however, would not occur if the vitality of the liver were much depressed; the result would be rather inflammation. Turpentine, which cures the jaundice, acts no doubt in the same way as when it arrests a gastric hemorrhage, stimulating the relaxed vessels to contract through the medium of their nerves. "14. The treatment of fever is to be ruled essentially by discriminating observation of the predominant pathological state, whether this approach nearer to excitement and irritation, or to pure debility and asthenia. In the former case it may be needful to bleed largely, as in tropical fevers (vide Dr. Copland, 'Fever,' p. 930); to give tartar-emetic and opium, as Graves did in typhus with violent delirium; or apply leeches to the temples, as Dr. Corrigan recommends in states of insomnia; or, as we so often do in the diarrhoea of typhoid, to leech the region of the cæcum, and give hydrargyrum cum cretâ and Dover's powder. All these are instances where lowering means are employed, with guarded caution. to quiet excited action. In the latter case, quinine, wine, and brandy, are to be administered freely, according to the requirement of the individual case. Dr. Stokes', Dr. Brinton's, and Dr. Shute's recorded experience is quite in accordance with my own. I may add, that I cannot but think the old idea that brandy and wine act beneficially by their stimulant effect on the nervous system, is far more satisfactory than the chemical notion that they act by affording a ready fuel to the respiratory process. It is the nervous system which most of all feels the effect of the poison; and it is reasonable to address our remedies chiefly to it. "15. In the treatment of pyrexia attending on local inflammation, it is impossible to prevent the effect while the cause continues. Any tonic or stimulant that could be administered to stay the paralysis of the vaso-motor nerves, would act injuriously as an irritant upon the inflamed tissue, impede excretion, and increase the existing mischief. Thus, in febrile eczema, arsenic aggravates the skin disease and the associated pyrexia. As long as the inflammation is of sthenic character, we must apply our efforts to reduce it; in the case of eczema, we leech the skin, or apply lead lotion, and give saline aperients. When, however, the inflammation has become asthenic, or is so from the first, there is either no fever, or it will yield with the inflammation to tonics. Thus, non-febrile eczema is often cured by arsenic, which probably tones the cutaneous vaso-motor nerves, and so contracts the arteries of the inflamed part. The distinction between the sthenic and asthenic inflammation, as to the effects of treatment, is all important, and seems sadly lost sight of in the bloodletting controversy." ART. 18.-On the Nomenclature and Classification of Continued Fever. By Dr. MURCHISON, Assistant-Physician to the London Fever Hospital. (Edin. Med. Journal, Oct. 1858.) One reason why many still refuse to admit the plurality of species of continued fever, is their neglect of the circumstances under which fevers originate. In a recent essay Dr. Murchison endeavors to prove that the class of continued fevers comprises three, or in all probability four, distinct species, originating from widely different causes. First, there is typhus, the grand predisposing cause to which is destitution; while the exciting cause, or specific poison, is generated by over-crowding of human beings, with deficient ventilation, and afterwards is propagated by contagion. Hence it is that epidemics of typhus occur during seasons of famine and in besieged cities; and hence it is that we find it limited to the most over crowded localities of large towns, and seldom meet with it in country districts, or in the upper classes of society. Secondly, there is the "relapsing fever," about which there may still be some doubts as to its specific distinction from typhus. There can be no question that it differs widely from that disease, both in its symptoms and mortality; and also that a previous attack of the one confers no immunity from a subsequent one of the other. On the other hand, relapsing fever is found to prevail, as epidemics, at the same times and under the same circumstances, as typhus. Researches are still wanting as to the distinctive etiology of these two fevers; but he has grounds for believing that it will yet be shown that relapsing fever is produced by famine alone; typhus, by destitution and overcrowding combined; in other words, that destitution and starvation are the predisposing causes of typhus, the exciting causes of relapsing fever. Thirdly, there is typhoid or enteric fever, which is less contagious than either typhus or relapsing fever, and which is quite independent of the causes which give rise to these, being generated by the putrid emanations from decaying organic (animal) matter. The grounds for this opinion may be briefly summed up as follows: 1. Previous attacks of either typhus or relapsing fever confer no immunity from subsequent attacks of typhoid fever (and vice versa). 2. There is no authenticated proof that the poison of typhus has ever generated typhoid fever (nor vice versâ.) 3. Typhoid fever does not prevail in wide-spread epidemics. It is essentially an endemic disease; or when it does become epidemic, such epidemics are always of the most limited and circumscribed character. 4. Typhoid fever is always most prevalent in autumn, or after a long continuance of hot weather. A hot autumn after a wet summer appears to afford the most favorable conditions for its development. 5. Typhoid fever is not, like typhus and relapsing, limited to the poor, but is met with among poor and rich alike. 6. Typhoid fever is not confined to overcrowded localities, but appears alike in the most dense and in the least populous districts of large towns, and even in isolated houses in the country. 7. There is evidence, of the most conclusive nature, that typhoid fever may result from the emanations from (animal) organic matter in a peculiar state of decomposition. In every instance where" fever" has been described as originating from such a cause, the fever has been typhoid. The reason why this cause is not more generally recognized, is the want of attention to the distinctions between the different fevers. Those who deny that "fever" can be the result of putrid emanations, adduce thousands of cases of typhus and relapsing fever as negative evidence, in the same way as there are not wanting a few who bring forward typhoid cases to prove that fever cannot be the result of destitution and overcrowding. Fourthly, there is simple fever, or febricula, which is non-contagious, and arises from such non-specific causes as exposure to the sun's rays, fatigue, surfeit, &c. In its simplest form this fever may terminate in twenty-four or thirty hours, as in the ephemeral or diary fever of systematic writers; or it may be prolonged to eight or ten days, as in the ardent or sun fever of tropical climates. Another reason why the various fevers are not more generally recognized as distinct diseases, is attributable to a faulty nomenclature. The term typhus, though derived from a single symptom, and so far objectionable, is one which is sanctified by great antiquity and a Hippocratic origin. The designation, relapsing fever, is no doubt inappropriate; for, in the first place, in a large proportion of the cases there is no relapse; and, secondly, it is hardly accurate to call that a relapse which is a constituent part of the ordinary course of the disease; yet the name is distinctive enough, and, in the present state of our knowledge, it might be imprudent to alter it. The same remark, however, does not apply to the appellation typhoid, to which I beg more particularly to draw attention. It is one which is not only faulty, but tends to create confusion. It is faulty; for, first, it literally means like typhus," and, conse quently, it is at variance with all precedent in the scientific nomenclature of natural objects, whenever it is desired to confer designations on distinct genera or species; secondly, because the same word is constantly employed, in an adjective sense, to indicate a group of symptoms, which may come on in the course of any disease; and, thirdly, a large proportion of the cases to which it is applied exhibit no symptoms of a typhoid character, or resembling typhus. For the same reasons, it greatly tends to create confusion; and indeed I have good reasons for believing that this name has done as much as anything else to make the public and the great body of the profession consider that the affection is merely a variety of typhus. At the same time, none of the numerous synonyms is, in my opinion, more appropriate. For example, it would not be desirable to have a name derived from the abdominal lesion, tending, as such would do, to revive in the minds of many the exploded doctrines of Broussais. A suitable distinctive name for the disease remains a desideratum; and after having devoted much thought and attention to the question, the author ventures, in the essay already referred to, to propose one, derived from what he believes to be the cause of the fever. In that essay he collects what, in his opinion, is conclusive evidence that typhoid fever is produced by the putrid emanations from decaying (animal) organic matter; and he therefore suggests for it the appellation of pythogenic fever - πυθαγενής, from πύθων (πύθομαι, putresco) and yevváw. In repeating this suggestion in a more prominent manner, he does so with considerable diffidence, and is actuated solely by the crying necessity there exists for adopting a more appropriate designation for the disease in question. The whole class of continued fevers may be said to occupy an intermediate position between the eruptive fevers (variola, scarlatina, and rubeola), on the one hand, and the malarious fevers (remittent and intermittent) on the other. As to the causes which originate the eminently contagious poisons of the eruptive fevers, we as yet know little or nothing; and if we have almost succeeded in eradicating one of these, our preventive measures have no reference whatever to the causes which generate it. The malarious fevers are non-contagious; and although we know little of the intrinsic nature of malaria, we have long known the causes and circumstances which give rise to these, and the prophylactic measures by which they may be in a great measure averted. Hence it is that agues, which in former times were so prevalent and so fatal in many parts of Britain, are now rarely met with. The continued fevers resemble the eruptive in being contagious, though to a less degree, while they are also assimilated to the malarious fevers, inasmuch as we know the circumstances under which they are developed, and the means by which they may, to a great extent, be prevented. The author is fully aware that the doctrines here enunciated are at variance with the deeply rooted convictions of a large body of the profession, who, while they admit that the various conditions specified in this paper may favor the propagation of the specific poison of fever already existing, yet deny that the poison of a contagious disease can be by any such means generated de novo. But if this view be correct, how comes it that the same conditions only give rise to one form of disease? If, for example, overcrowding only acts by favoring the propagation of typhus (that it does thus act he is far from denying), how is it that, in temperate climates, it is always typhus which appears as an epidemic in a besieged city, or in an overcrowded prison, and not diseases which are notoriously more contagious, such as variola and scarlatina? In fact, with regard to typhus and pythogenic fever, the matter resolves itself into this: if certain conditions are present, we can, with almost certainty, predict the result. Pythogenic fever may be said to form the connecting link between the continued and the remittent fevers. It is but sparingly contagious. There is also much that is remittent in the history of the course of the disease-so much so, that many of the designations which have been bestowed upon it have reference to this character. There can be little doubt, he thinks, that the hemitritæus or febris semitertiana of old writers, which was considered a composite disease made up of a tertian and quotidian intermittent fever, was pythogenic fever; while it is now generally admitted that the so-called "infantile remittent fever" is of the same nature. Again, there are not a few well-authenticated instances of pythogenic and malarious fevers prevailing together, and apparently generated under similar circumstances. Such is the case, Dr. Mercer Adams tells us, every summer in the foul-smelling city of Amsterdam. A most remarkable instance of this intimate relation between the two fevers will be found in an account of the diseases observed in the commune of Guermange, in the Duchy of Lorraine, and presented by M. Ançelon to the French Academy of Sciences in 1845. There are also good grounds for believing that careful dissections will show that many of the so-called remittent fevers of tropical climates are typhoid or pythogenic. Already Drs. Scriven and Ewart, of the Bengal Medical Service, have proved, by post-mortem examinations, the existence of pythogenic fever in India and in Burmah. Dr. Scriven, who studied the characters of the disease under Dr. Jenner, at University College, has given figures of the intestinal lesion, and has written that he has met with several other cases of the same fever since the date of his papers. It will be important to ascertain what are the precise circumstances under which such cases are observed in India, and whether they are not different from what are known to develop the more prevalent malarious fevers. With regard to these last, the common opinion at present is, that, although the putrefaction of vegetable matter is a frequent concomitant, it is not an essential part of the process of the development of malaria. This opinion is founded on the facts recorded by Chisholm and Fergusson; but both the facts and the opinion require reconsideration. Without entering into this question at present, the author would merely record his opinion, that it is highly probable that vegetable putrefaction is the source of malarious fevers, while the putrefaction of animal inatter begets pythogenic fever. The paper concludes with a summary, giving the synonyms of each form of fever (a task of no small labor), with the leading distinctive characteristics. ART. 19.-On the Use of Powdered Charcoal and Magnesia in Typhoid (Rév. de Thér. Méd.-Chir., June, 1858.) At The description of the cases in which these medicaments were employed is not sufficiently exact to enable us to arrive at a correct opinion respecting their value. We cannot tell, indeed, whether the cases were slight or severe. the same time, we think it not improbable, from what we know of the modus operandi of the medicaments-a modus which would be at once disinfectant and evacuant-that the effects may have been, as they are said to have been, not a little beneficial. ART. 20. On the Action of Calomel in Typhoid Fever. (Archiv. für Physiol. Heilkunde, New Series, vol. i. 1857.) In 550 cases of typhoid fever, treated during seven years, Dr. Wunderlich has used calomel seventy-six times. As a rule, this treatment was commenced before the expiration of the first week of the malady, and the cases were always of a marked and severe character. If the cases were slightly marked, if there was diarrhoea, colic, or flatulent distension of the bowels, or if the patient was anæmic or liable to scorbutic hemorrhage, calomel was not given. A single dose of twenty-five centigrammes, or of twenty to fifteen centigrammes, according to the age of the patient, once or twice a day was the plan adopted. Of the seventy-six patients who took the calomel eleven died-a proportion which, according to the author, is below the average mortality in this affection. Moreover, seven of these eleven deaths were exceptional; thus, four did not have the medicine until the best time for its administration had been past by considerably, two were almost moribund before they had it, and the remaining one died of an accidental illness contracted during convalescence. Excepting these seven cases, then, the proportion of deaths falls to not more than four in sixty-nine, or five to six per cent. In no instance could any injurious influence be attributed to the calomelneither diarrhoea, nor flatulence, nor head-symptoms, nor feverishness. Slight and transient ptyalism was the only inconvenience, and this was by no means present in all cases. Comparing these cases with those in which this disease was left to its own course, Dr. Wunderlich considers that the calomel was decidedly beneficial. In twenty-five cases, he thinks that the intensity of the malady was decidedly diminished, and that in five the course of the disease was actually cut short. He thinks, also, that in the other cases the patient was not only not harmed, but benefited, and that in all the cases the follicular disorder of the intestine was checked by the use of the calomel. ART. 21.-Some Observations on the Treatment of Smallpox. By Mr. MANDEVILLE, Surgeon to 3d India Depôt Battalion, Chatham. Out of thirty cases treated in this way, the author tells us, only one proved fatal. Of these cases, moreover, more than half were confluent, and about ten of an aggravated character, the throat being in all more or less affected, and the greater number having been subsequently complicated by the formation of numerous abscesses over the body, the face excepted. "As is the custom in all military hospitals, fever cases are immediately admitted when they present themselves; and, during the prevalence of the smallpox, the first symptoms of any eruption were carefully looked for, and the more especially in the present instance, as both rubeola and scarlatina were also then prevailing; and, upon ascertaining that the eruption was smallpox, the patient was removed into the hospital set apart for that disease. "The treatment up to this time was the same as for common continued fever, but I now commenced what may be termed the specific treatment. The patient was directed to take a mixture composed of two drachms of compound rhubarb powder, two drachms of tincture of hyoscyamus, and seven and a half ounces of camphor mixture, in doses of two tablespoonfuls three or four times a day; but, if the attendant fever was very high, there were added two ounces of the solution of acetate of ammonia to the above. This mixture was generally continued as long as the fever lasted, which was usually about the time when the pustules had fully maturated and the scabs had formed, the fever seldom extending beyond that period. It was then omitted, and bark ordered, if there had been great prostration, after a serious attack. A draught, containing one drachm of tincture of hyoscyamus in an ounce of camphor mixture, was given at night, as soon as the patient complained of any restlessness or itching, which was about the second or third day of the eruption in the confluent form; but they sometimes complained of it on the first day, when the eruption appeared to be retarded, as if struggling to force its way through the cutis vera. This was continued every night as long as the sleeplessness from the pruritus continued, and at the same time the following liniment or ointment was laid on with a large-sized camel-hair brush three or four times a day over the face and any other part of the body of which the patient complained of being itchy, viz., half a drachm of extract of belladonna, rubbed up with half a drachm of spermaceti ointment, to which were added three and a half ounces of olive oil and two and a half drachms of chloroform. The cerate was added to give it consistence and hold the chloroform in suspension, but the bottle must, notwithstanding, be well shaken before using, as the chloroform will subside after standing for any time. "In giving the above as being generally sufficient, I should have said, as the basis of my treatment, I wish it to be distinctly understood that I do not mean it in an empirical sense, as every case of smallpox must be treated according to the individual symptoms, and the practitioner must be prepared to meet every contingency or complication of other organs that may arise, either of the head, chest, or abdomen, and act accordingly; but, as far as I can at present judge, it appears to me that by adopting the above mode of treatment, the tendency to such complication will be much diminished or modified. "I may here say a few words on the rationale of the treatment. The mix |