cases under treatment consisted of Fever; and there was a like proportion of "local complaints." Dysenteric disorders range next in point of frequency, being about one in every eleven. Then follow Rheumatism and Indigestion. To these succeed (in the order mentioned) Syphilis, Cephalic Inflammation, Diarrhoea, Hepatic Disease, Abdominal Inflammation, and lastly Cholera: the cases of this last disease did not exceed th of the whole number. We may, en passant, remark that there is no such thing, however frequently it may be named in common parlance, as what is usually called a "seasoning fever." The disease, that the recruit may first experience after his arrival in the East Indies, depends on a variety of circumstances not immediately connected with the mere change of climate; such as the nature of the locality to which he is sent, his habits, exposure to weather, and so forth.

We commence with the consideration of

FEVERS.

This order of diseases is at once the most frequent and most important of all that are met with in our East Indian Hospitals, as well of the native as of the European troops. During the space of five years, nearly 1800 cases are reported to have occurred in the Madras European regiment. They are arranged by Dr. G. under the heads of Continued, Ephemeral, Intermittent, and Remittent Fevers. The two first form but a small proportion of the entire number; it is with the two last that we shall have chiefly to do in the following observations: we shall therefore begin with them.

Intermittent and Remittent Fevers.

With respect to the complete identity in nature of these two most frequent forms of pyrexial disease, our author remarks:

"It is observed that, on the arrival of a body of men at an unhealthy station the hospital becomes gradually filled by patients who are found to have attacks of fever daily, or every second day. In some of them, the frequency of pulse and other symptoms descend to a natural state between each paroxysm of fever; and in others, a certain degree of pyrexia remains at the accession of the following paroxysm. Patients are daily received under each of these circumstances; and in cases of relapse, the intermittent of one admission has occasionally become a remittent in the next, and vice versa. The succession of symptoms and progress of each paroxysm, correspond in either variety; and at the same time it is found that the remedy which is specific in one form, possesses the same powers in checking the other. In short, apparently the produce of the same cause, showing similar symptoms, and removed by the same means, there seems no difference between these two forms of disease, but that of severity. It is true that, in certain stages of some instances of remittent, symptoms become superadded which have no corresponding appearance in cases of intermittent; but they are the result of the violence, or, along with this, the duration of the disease; and their frequent occurrence, or otherwise, indicates the degree of severity in an epidemic attack, or, occasionally, the method of treatment employed. Believing, therefore, all these cases of a fever in paroxysms to be of the same nature, whether having a remission, or an intermission between them, it is intended to

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apply the term Paroxysmal to these diseases in general; in contradistinction to that of Continued, as given to Synocha, and others."-P. 90.

These fevers were comparatively rare in the regiment while it remained at Masulipatam on the sea-coast, compared with what was the case at Kamptee, commencing with the first rainy season there. They prevailed more in the months of August, September, and October (during and immediately after the rainy season) than in any other part of the year; gradually diminishing, in point of frequency, during the cold months, and again increasing in March and April with the returning heat.* The prevalence of the fevers was uniformly observed to be proportionate to the amount of rain that fell during the wet season, coupled with the degree of heat of the weather before and after the fall. Much too, doubtless, depended, in respect of morbific influence, on the range or variation of temperature experienced in the course of the twenty-four hours, during the sickly season. Indeed, as Dr. Geddes observes, " an alternation of temperature appears necessary to excite the phenomena of Paroxysmal Fever; and the course of this change is observed to be the occurrence of heat after that of cold, combined with moisture."

The age of the individual seems also to have a good deal to do with the degree of his liability to be affected with the febrific miasm. Those men at or beyond the age of twenty-five were observed to be decidedly less liable to fever than those à few years younger. "Of 193 persons who in 1830 were under the age of twenty-five, 100 were affected in the first year of their sojourn at Kamptee, and only 38 escaped altogether; while of 276 individuals, at and beyond the age of twenty-five, 99 were affected in their first season at this station, and 81 had no fever previous to the period of the author leaving the regiment.

The same thing was observed in respect of the tendency to a recurrence, as of that to the first attack, of the disease; for there was a larger number of relapses in those below, than in those at and above, 25 years of age. Among the soldiers, the Scotch suffered less than the English and still less than the Irish. Is this to be attributed to their greater sobriety'?

With respect to the influence of longer or shorter residence in India on the liability to attacks of Fever, it is by no means easy, as will appear by the following extract, to arrive at any definite conclusions.

"It appears, that those having been the shortest period in the country-who were generally, however, the youngest soldiers were most liable to be attacked with the disease; that, beyond a short sojourn there, an interval seemed to occur where individuals appeared less liable to be affected: but that the tendency rather increased afterwards, until the age of the soldier, perhaps, became an auxiliary in enabling the constitution to resist the cause of the disease. Thus of 444 individuals, whose residence in India was ascertained on the 1st of July, 1830, in 132, whose stay there had not extended beyond two years at that date, 108 had Fever in the three following years, instead of 95; which should have been the number attacked, according to the general average. In 54, whose residence had been from two to three years, this average was observed; those from three to four

*September was, on the whole, the most sickly, and February the least sickly, months in the year. Such was the case at Kamptee; but this statement does not hold good as respects other parts of India.

years, who amounted to 160, had two less than the general average; 37, again, whose residence extended to different periods from four to eight years, rather exceeded the average; while of the remaining 61 persons, whose stay in India had been more than eight years, 35 only had Fever, instead of 44, which should have been the number according to the proportion at which the Fever generally prevailed. Length of residence has, perhaps, little effect in the prevention of an early attack; a fully equal proportion of the older residents being affected in the first season of their sojourn at Kamptee as of those who had been a shorter period in India. Of 22 individuals, however, who suffered from eight to twelve attacks of the disease, four had been only one year in India at the period of the first accession of Fever; five had been two years; seven had been three; and three had been four years in India. The remaining three had been seven and nine years in that country. It would appear, therefore, that the greater proportion of those having many relapses had been but a short period in India; but the effect here may be divided between the influence of youth and that of the short sojourn in a warm climate."-P. 112.

Before alluding to some of the more remarkable phenomena of Intermittent and Remittent Fevers, Dr. Geddes makes the general observation that the descriptions, that have been given of these fevers by many preceding writers, would have been much truer to nature, and therefore more useful to the young practitioner, if they had been considered and described, not as distinct maladies, but merely as different degrees of one and the same disease, exhibiting the same general features, and requiring the same general principles of treatment.

With a view of establishing a distinction between the Remittent and the Intermittent forms of Fever, it has too often been the practice of authors to select only the most strongly marked cases for description, omitting the less decided, but perhaps more important, forms of the disease; and, all the while, but little information is given as to the relative frequency with which it makes its appearance in these decided forms.

Whenever the pulse fell down, in the intervals between the pyrexial paroxysms, to 72, the case was considered by Dr. Geddes as one of Intermittent fever; and when it kept above this mark, it was set down as one of Remittent.

After a variety of minute statistical details respecting the frequency of each of the usual symptoms of Fever, we come to the following notice of the Spleen, as one of the viscera that is very often affected:

"In 35 cases, some degree of pain in the site of the spleen is reported to have been felt, at certain periods of their progress. This pain has generally been increased by a long inspiration; and, sometimes, is stated to have been so by coughing, vomiting, walking quickly, or by lying on either the right or left side. It has, occasionally, extended towards the breast and left shoulder, or towards the pubes or umbilicus. The period of the case at which this symptom has been noticed, has most frequently been about the second or third day after admission; but in some instances it has preceded this event, and in others, been of later occurrence. It has generally been of speedy removal; but sometimes has continued for a short while after the tendency to Fever has become checked. In only one of these cases was there appearance of enlargement of the spleen; and, from the effect of remedies, it seems most likely that the pain reported in the site of this organ, or near to it, has, in the greatest number of instances, depended upon obstruction of the bowels near to this situation. The spleen was found enlarged in another case of Fever, after the patient had suffered twelve

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paroxysms of Tertian Fever, before coming to Hospital; but in no other instance was any affection of this viscus to be observed."-P. 130.

In all cases, without exception, the abdomen should be most attentively examined, more especially in both hypochondria, and along the head and tract of the colon. It is uniformly of first-rate importance to relieve local irritation, at the same time that we seek to arrest the constitutional disturbance. In some cases, the Headache and Vertigo are the most annoying symptoms present. Under such circumstances, the effects of the quinine require to be narrowly watched; as this medicine is unquestionably liable in some constitutions to aggravate, if not to excite, the headdistress.

As to the hour of the day at which the attacks of paroxysmal fevers usually take place, we read:

"It has been remarked that where the paroxysms of Fever are disposed to recur at certain intervals, their accessions more frequently take place at one period of the day than at another. This fact is exhibited in the Table given in the next page, where the usual hours of attack in the cases of each type of Fever are arranged. It will be there observed, that the general tendency of the Tertian interval as shown in the one paroxysm of the single, and in the corresponding or more perfect fit of the double cases-was to have the accession of Fever at an earlier period of the day than in the Quotidians. Thus of 421 of the latter, the attacks occurred before noon in 161, and in 260, after that hour: while of 776 single and double Tertians, the Paroxysms took place in 659 in the earlier half of the day, and in only 117 in the latter portion. Another circumstance which has been remarked, is, that where there have been more than one or two admissions with Fever in the same person, the after attacks observe a considerable degree of similarity in their hours of accession as well as in their type: that, in short, where the system has become accustomed to Fever, a certain regularity of type and hour of accession is assumed: the exceptions to this rule being produced, it is believed, by accidental causes, at or previous to the commencement of the attack. It is difficult to exhibit, in a tabular form, the facts which tend to prove the truth of this observation; but it may be remarked, that they consist of a general view of the respective hours at which the several relapses of each patient took place; and the types of Fever which they presented. The result of this enquiry is, that, in cases where there were more than two attacks, there was generally a great predominance of the relapses of the same type, and occurring at the same period of the day; and that this was particularly remarkable among the Tertians, and their usual hours of accession; namely, the earlier portion of the day.”—P. 137.

With very few exceptions, the febrile paroxysms occurred at some period of the day-time.

As

The Intermittents were, upon the whole, one-fifth more numerous than the Remittents; but the relative frequency of the two forms was found to vary a good deal in different years and months. The Remittents were most numerous from July to November, and especially in the month of September. It was observed that the proportion of Remittents gradually diminished, as the residence of the men was prolonged at Kamptee. a general result, it would seem that, when Fevers are most prevalent, they are usually the most severe, and most disposed to assume a continued type; and that they diminish in violence according to the length of time. of a person's exposure to the febrific cause, and also according to the number of relapses which he has experienced. Hence, Intermittents pre

dominate during the less sickly months, while Remittents are most frequent during those that are most unhealthy; and hence also the fact that by far the greatest number of relapses exhibit a simple tertian character. There were only thirteen instances of Quartan observed out of the whole number of the cases that were treated; these occurred, with two exceptions, in the period when least fever prevailed, viz. in the seven months commencing from October. In two individuals no other type of fever was observed; but in the remaining cases, the patients had all suffered previously either from Quotidian or Tertian fever. In four cases, the disease was checked before the third paroxysm occurred; in six cases, the paroxysms reported to have taken place were three, four, or five; in the remaining three cases, the disease had recurred at each quartan period for the space of one or two months. The cases of Quartan were observed chiefly in men about 29 or 30 years of age, and who had been from five to ten years in India.

The diagnosis of Paroxysmal Fever is usually abundantly obvious, if the symptoms be accurately recorded at two distant periods of the day, and due attention be paid to the nature and history of any attendant local affection. Cases, however, are every now and then occurring which will somewhat perplex the less experienced practitioner.

"There are three classes of disease, for which it is liable to be mistaken; one, where a febrile state is the predominating complaint; another, where any of the common topical accompaniments of Paroxysmal Fever exist, and are attended by pyrexia; and the third, where a Fever is present, putting on the paroxysmal form, but having its origin in some organic visceral disorder. In the first class are comprehended those ephemeral attacks arising from excitement by heat, drinking, and the like, or from disorders of the chylopoietic organs, or exposure to cold and moisture; in the second, are comprised certain cases of cephalic or splenitic Inflammation or Rheumatism, and Cholera, all of which, when Paroxysmal Fevers are numerous, may put on so much the appearance of these Fevers as to be confounded with them; and, in the third, are included cases of Hectic Fever arising from Hepatic abscess, Phthisis, or other extensive organic lesions producing constitutional irritation. In distinguishing such disorders from Remittent or Intermittent Fevers, the medical attendant will be chiefly guided by the prominence or presence of peculiar symptoms, or their more or less continued nature and duration; and it may be here remarked, as has been already adverted to, that nothing will be found to assist him more in arriving at a correct knowledge of the nature of the disease under treatment, than accurate and minute records of the symptoms of the case, combined with the information which a series of such reports will afford, respecting the previous history of the patient."

P. 150.

The results of the treatment pursued in the 1210* cases which occurred in the quadrennial period of Dr. Geddes' service must indeed have been highly gratifying to him; only one proved fatal. This great success was doubtless owing partly to the promptitude with which the disease was encountered, partly to the general mildness of its character, and in part also to the skill which our author, from his long and multiplied experience

*It would seem that nearly 200 cases more had occurred during the period referred to; but, as these cases were attended by other medical officers doing duty at the time with the corps, they are not taken into consideration at present.