plication of some direct or indirect stimulus, or sedative, to the human body, the equilibrium of the circulation of the blood is destroyed; and that which we call fever, is an effort of the vis medicatrix naturæ, to re-establish this equilibrium. If Nature be assisted in her earliest endeavours, she will often succeed; if left entirely to herself, the contest will be long and doubtful; and the destruction of the structure of the organ in which the accumulation has taken place, and the death of the patient will be the consequence.

During this reaction of the system, a something capable of exciting a similar disease when applied to a person in health, is sometimes formed. What this something is, or upon what peculiarity of action its elimination depends, I will not pretend to explain its presence, however, appears to constitute the principal difference between fevers which have been considered purely symptomatic or inflammatory, and contagious or typhus fever. I have never known a fever prove contagious, where the brain has not been the organ primarily af fected.

All fevers are inflammatory; the division of them into inflammatory and typhoid is prejudicial; it deters many from employing the proper remedies. A better, more useful, and a more natural division of them, is into contagious and non-contagious inflammatory affections.

CHAPTER II.

Typhus.

Morbus contagiosus; calor partim auctus; pulsus parvus, debilis, plerumque frequens; urina parum mutata; sensorii functiones plurimum turbatæ ; vires multum imminuta.-Cl. i. O. 1. G. v. CULLENI.

ALTHOUGH the theory of Fever, advanced in the last chapter, does not explain all its phenomena, a success

ful practice may be founded upon it. During the last five years not more than twelve patients have died of Typhus at this Infirmary; the number admitted cannot have been less than two hundred.*

I am of opinion, with my kind friend and preceptor, Dr. Clutterbuck, that the seat of genuine Typhus (a fever distinguished by being contagious) is the brain. It is true that I have seen fever, arising from inflammation of the lungs, liver, and internal coats of the stomach,† bear a very strong resemblance to genuine Typhus. So marked has the resemblance been in the last stages, that it would have been impossible for any one, unacquainted with the previous history of the cases, to have distinguished them from Typhus. In these cases, however, the brain was secondarily affected; and I do not remember a single instance in which they proved contagious. How often is the dissolution of phthisical patients preceded by all the symptoms usually considered typhoid : delirium; indistinct articulation; parched brown or black furred tongue; hot, dry skin; feeble, fluttering, rapid pulse; subsultus tendinum, &c.! but who thinks of calling the disease TvPHUS?

Treatment.

In the first approaches of Typhus we shall frequently be able to prevent the disease from establishing itself, by administering an emetic. Should this be found insufficient to prevent the formation of a febrile paroxysm, as soon as the hot stage of it is fully formed, we must

The precise number of cases cannot be ascertained, as many patients, admitted with other diseases, were attacked with fever after their admission; no memoranda of which are kept in the Registers of the Hospital.

The cases reported as typhus, were certainly characterized by the symptoms of that disease; the brain, however, was only secondarily affected; and it was easy to distinguish a determination of blood to some other organ. Strictly speaking, therefore, perhaps not more than one hundred genuine cases of typhus have been admitted within the period mentioned.

+ See CASE XXV.

take away some blood from the arm, regulating the quantity by the strength of the patient, and the violence of the symptoms. As a general rule, we must be guided in the quantity according to the force with which the blood is driven towards the brain, and the consequent disturbance of its functions. The pulsations of the carotid artery will enable us to determine this point better than if we trust to an examination of the pulse at the wrist.

In the treatment of typhus fever we must be careful not to mistake indirect for direct debility. This we shall be very liable to do, if we form our opinion by the state of the pulse. In the early stages of the disease, it will be often found soft, slow, and feeble. This state of the pulse is not a mark of direct debility, but is the consequence of an accumulation of blood within the brain; by which the energy of that organ is impaired.

When treating of the functions of the brain, it was stated that the nervous fluid, in which the living principle resides, is formed by it. If an interruption from any cause be given to the due performance of the functions of the brain, debility, or a diminution of the pow ers of life, must be the result.

Instead therefore of inducing debility by the abstraction of blood in the early stages of typhus fever, we shall, by its removal, enable the brain to reassume its functions.

Emetics and venesection will, if employed very early in the disease, generally put a stop to its progress. If these remedies be omitted, and several febrile paroxysms allowed to form, all our endeavours to shorten the disease will prove abortive. A palliative treatment is all we can employ with any advantage. We must prevent an accumulation of fæces, by giving every night, or every other night, five grains of antimonial powder, and five grains of calomel. This combination will generally procure two or three dark, fetid stools; by their evacu

ation, the patient will be much relieved. The patient must be supplied freely with cool acidulated liquors; cool air must be admitted into the apartment, and whenever the skin is hot or dry, it must be sponged with either cold or tepid water. I generally direct a small quantity of vinegar to be added to the water, to quiet the apprehensions of the patient, or of the attendants. I have never seen cold affusion applied in the manner recommended by the late Dr. Currie, of Liverpool. Its efficacy in the early stages of the disease is well attested; in its second, or more advanced stage, simple ablution appears to me preferable. Relief will likewise be obtained by the frequent application of leeches to the temples. In this, as well as in the first stage of the disease, stimulants are to be abstained from.

In the third, or last stage of Typhus, I scarcely know what line of treatment to recommend. There is a point at which stimulants either do good, or accelerate the death of the patient. I think, however, that they will be more frequently found useful than prejudicial. The best stimulant is port wine. A table-spoonful of it may be given every hour; nutritive broths, from time to time administered, and a blister applied to the nape of the neck, or between the shoulders. In the early stages of the disease, blisters have appeared to me somewhat injurious, particularly when applied to the scalp. In irritable habits, they will sometimes accelerate the pulse, and give to it a peculiarly thready feel.

Recapitulation.

It will be seen that I have divided the treatment of typhus fever into three stages. In the first stage, we are to administer emetics, and employ venesection. In the second stage, we are to moderate the reaction of the system, by the admission of cool air, sponging the body, &c.; and by emptying the bowels, by administering calomel, in combination with antimonial powder. In

third and last stage, we shall more frequently benefit than injure the patient, by giving him wine, broths, &c.

CHAPTER III.

Febres Intermittentes.

Febres, miasmata paludum ortæ, paroxysmis pluribus, apyrexia, saltem remissione evidente interposita, cum exacerbatione notabili, et plerumque cum horrore redeuntibus, constantes: Paroxysmo quovis die unico tantum.

Tertiana.

Paroxysmi similes intervallo quadraginta octo circiter horarum: Accessionibus pomeridiannis.—Cl. i. O. i. G. i. CULLENI.

Quartana.

Paroxysmi similes intervallo septuaginta duarum circiter horarum: Accessienibus pomeridianis.-Cl. i. O. i. G. ii. CULLENI.

Quotidiana.

Paroxysmi similes intervallo viginti quatuor circiter horarum: Paroxysmis matutinis.-Cl. i. O. i. G. iii. CULLENI.

INTERMITTENTS, whether tertian, quartan, or quotidian, require nearly the same treatment. The accession of the paroxysms may be, for the most part, prevented, by exhibiting an emetic about half an hour before its cold stage is expected. In delicate habits, when the emetic fails to produce its intended effect, twenty drops of the tincture of opium will sometimes succeed.

In plethoric habits, much advantage will be gained by bleeding the patient in the hot stage. We may succeed in breaking the diseased chain of action, in obstinate quartans, by resorting to this practice, after every other means have proved insufficient. In several cases of extreme obstinacy, the patients were put under a copious