fever, there seems to be a greater probability that the local symptom shall be connected, or is really connected with local irritation than it is here. He took, in the first place, twelve fatal cases of typhoid fever, which did not present the symptom of delirium. In four of these cases he found redness of the brain, in six the brain was perfectly healthy, and in two there was slight softening of the brain. Now, let us take his twelve other cases, in which delirium was an extremely prominent symptom. In many of them the patients were violently delirious. In five of these cases there was redness of the brain, in five the brain was perfectly healthy, in one there was slight softening, and in one slight injection. Now, compare these two sets of results, and see how extremely similar they are. Where there was no delirium four patients presented redness of the brain; where there was delirium five presented redness of the brain. Where there was no delirium six presented the brain perfectly healthy; where there was violent delirium five presented the brain perfectly healthy. The other cases may go for nothing. This result is extremely valuable indeed, as showing how very little we can depend upon the symptoms of excitement of the brain, as an indication of organic disease when the patient is in fever.

Now, let us go to some other organ, take the heart. "Well,” you will say, "the heart need not to be taken, because in most of our cases the heart shows a depressed state, and not an irritated state." But there are many cases of fever in which the heart is violently excited, as you will have frequent occasion to see. What is the result of dissection in those cases of excited heart in fever? There are two conditions which, according to ordinarily received notions, should lead you to expect irritation or inflammation of an organ: first, that the patient has fever, and next that you have an organ in a state of great excitement. If the patient had not typhus fever, but had fever which was not typhus, and an excited organ, the chance would be, that that organ would be found in a condition of inflammation. If a man has fever which is not typhus fever, and his lungs are excited, we find bronchitis or pneumonia; if his pleura is excited, we find pleuritis, and so on. But here is a case of typhus fever, with extraordinary excitement of the organ, and when you come to dissect the parts you find the heart perfectly healthy, not the slightest sign of disease is found; and the same observation will frequently apply to the digestive system. You will have tenderness on pressure of the abdomen, extreme thirst, nausea, and vomiting. Yet, on dissection, the mucous membrane will be found pale, and there will be no sign of disease. If a patient who had not typhus fever had a red tongue, or a dry and cracked tongue; if he had thirst, if he had vomiting and tender epigastrium, every one would say, this patient has gastritis, and, in all probability, he would have gastritis. But in fever, the state of the tongue is no sign whatsoever of gastritis; for each of you who has worked in the fever wards here must have seen that we are

totally regardless of the condition of the tongue in the administration of the most powerful stimulants; and we find that one of the best modes of removing the redness of the tongue in fever is to give hot brandy, or large quantities of wine, or such stimulants as bark and

ammonia.

Again, take the eye. Delirium ferox with an injected eye is the expression of inflammation of the brain where the patient has not typhus fever. But take a case of fever, and is the injected eye a sign of cerebritis? Certainly not. It is merely to be looked upon in the same way as the tongue-it is a local affection under the dominion of the general disease. The truth is, that disease of a true inflammatory character is the rarest thing possible in fever; it is so rare, that some do not believe that it ever occurs. Apply this axiom, then, to treacment, and see what becomes of that doctrine which advocates bleeding in fever, which advocates starvation and purging in fever, which forbids the use of wine, and other stimulants. There is another very important view or argument to be referred to here, which all practical men will understand. If fever was a group of inflammations, or if it was symptomatic of any one inflammation; in other words, if it was an inflammatory disease, we ought to expect that in the larger number of patients who had gone through the process of fever, chronic diseases of organs would be developed. If a patient has acute rheumatism, we find that his heart may become engaged. He recovers from the rheumatism, and then he has a progressive organic disease of his heart. When you reflect upon the extent of fever, the great number of persons that have been at some time in their lives attacked with fever, you should at once come to the conclusion, that if those fevers were examples of groups of local inflammations, we should have a much greater quantity of organic local diseases consequent upon them : but what is the fact? The fact is, that such accidents are extremely rare. How few cases can be adduced of confirmed mania as a consequence of fever! How few cases can be adduced of paralysis, of apoplexy, or of hydrocephalus, as a consequence of fever! Surely, if in this enormous number of cases of fever with violent head symptoms, there had been inflammation of the brain, in some of them, at all events, we should have, as a consequence, progressive disorganization of the part. Again, take the thorax. How few instances are there on record of chronic progressive pneumonia after fever; how few of chronic pleuritis; how few cases of atrophy of the lung; how few cases of anatomical changes which end in progressive organic disease, which has started from an inflammatory disease that took its origin pending a fever! Go to the heart. We have two classes of heart affections in fever: one, a softening and weakening of the heart; and the other, an excitement of the heart. I don't care which of them you take. Do we find that, after a recovery from fever, in persons who have had either of those affections of the heart during the fever, there is a liability to valvular disease, that there is a

liability to hypertrophy of the heart, that there is an adhesion of the pericardium? Nothing of the kind results. The fact is, that those organs have never been in a state of inflammation. They have suffered pending the fever, and, the fever having left them, the parts are restored to their normal condition. This is a very important consideration, and you may extend it still further. If fever were an inflammation of the blood-vessels, it is not to besupposed but that we should have many cases of disease of the aorta in the thousands of persons who have gone through fever. Yet we find no such results. If you go to the digestive system, (and this is, perhaps, the system, of all others, which is the most liable to organic change, at least in the Continental fevers,) take the peritoneum. How few cases do we find-or have we any case to show-of chronic peritonitis, as the result of the typhus fever? Not one that I know or ever read of; and yet the patient may have had symptoms of severe irritation of the abdomen pending his fever. In fact, all that we know of disease of the peritoneum, in connexion with fever, is simply, that, in certain cases of ulceration of the intestine, a solution of continuity of the peritoneum takes place, and the fæcal matter is effused into the cavity, and the patient dies of acute peritonitis. But that does not touch my argument. Where are the cases of chronic disease of the liver springing out of typhus fever? It has been long a portion of medical doctrine,-it has become a traditional doctrine, and everything that is traditional in medicine is to be respected, that fever has a depuratory effect on the system. Now, whether it has a depuratory effect or not, we shall not here inquire; but the very fact of the existence of that doctrine, which is much older than pathological anatomy, implies, at all events, a very general belief that fever does not damage organs; for, if it did damage the various organs that exhibit local symptoms in the course of the affection, we should not have the doctrine established of its having a depuratory effect. The cases of the establishment of a chronic ulcerative condition of the intestinal tube might be adduced in opposition to these views, but I do not place much weight upon them. We may divide them into two classes; in the one, diarrhoea, or some other symptom is established during the fever, which latter runs on indefinitely-here the typhoid disease of the mucous glands has been attended with re-active irritation, and this has interfered with the action of the law of periodicity so that the fever runs on indefinitely. In the next case, the fever may be supposed to have ceased, but so much disorganization has occurred, that the ulcerative process seems to go on as it might be supposed to do in another case where no typhus had preceded it. The cases related by Dr. Cheyne, in the first and second volumes of the 'Dublin Hospital Reports,' appear to be examples of these forms of disease.-Medical Times and Gazette, April 8, 1854, p. 339.

2.-ON THE PROPHYLACTIC INFLUENCE OF QUININE IN FEVER.

By DR. ALEXANDER BRYSON, R.N.

[It has long been a standing rule in the navy for the surgeon, if he deem it advisable, to allow to every one going on shore in tropical climates, a certain quantity of quinine in wine, or spirits, as the case may be. This rule has not been strictly adhered to, because in some cases it seemed to have no effect; but, says Dr. Bryson,]

Convinced that the preventive influence of bark and quinine had never been fairly tried, in drawing up a Report on the African station, in 1847, I suggested that the latter should be given, not exactly on a different plan, though with a somewhat different object in view. Up to that period, bark had been used only during the time the men were exposed on shore, or while absent in boats near swampy places, and, as I have understood, for the purpose of acting as a tonic, and thereby protecting the system against the influence of fever-exciting miasmata. Immediately after they returned on board, the bark was discontinued. This was evidently wrong; for, although we know that both bark and quinine will prevent the occurrence of aguish paroxysms, and probably prevent the evolution of remitting fever, still we do not know, nor have we any reason to believe, that they have any effect whatever in preventing the peculiar exciting cause, or, to use the more familiar phraseology, the morbific germs of the disease,-from entering the system, or that they have any permanent neutralising power over them after they have entered it. It was therefore clear that when the influence of the bark or quinine so administered had ceased, the evolution of the fever might take place at any time within twenty days from the day the persons were last exposed on shore, or to miasmata productive of fever, though in nine cases out of ten the incubative period does not exceed fifteen, sixteen, or seventeen days. Up to the fourteenth, however, the disease may occur with as much force as on any intermediate day from the first; but after that, if developed at all, it is seldom that the fever either runs high or lasts long. With the most perfect faith in the preventive influence of quinine, and trusting to its well-known antagonism to the recurrence of periodic diseases, in the above-mentioned report I suggested that "quinine being less nauseous than bark, and therefore less likely to be refused by seamen, it should be used as a prophylactic instead of the latter, and that its use should be continued, not only while the men were exposed in unhealthy localities, but for at least fourteen days after they returned on board, in order that the antagonistic influence of the medicine might be kept up until the incubative period of the disease had expired. The suggestion was adopted, and the results, upon the whole, are most satisfactory.

A strong, spirituous solution of amorphous quinine was mixed with several pipes of wine, in the proportion of four grains of the salt to an

ounce of the wine; a number of cases, or boxes, was then made, capable of holding a certain number of bottles; these, on being filled with the medicated wine, one or two boxes, according to the size of the vessel, were supplied to each cruizer employed on the African station. The object in supplying the cruizers with medicated wine-chests was, that they might at all times be ready and at hand to put into boats suddenly required to proceed on detached service. Thus the quinine, --which, when carried in paper, or bottles, was not only apt to be lost or blown away, but had to be given in uncertain doses, and therefore could not be husbanded-was secured, and the wine was effectually destroyed for any other purpose. Instructions for the administration of the wine according to the above plan were placed in each box, and the medical officers were requested to note and report on its effects. The following extracts will show the estimation in which it is held by the medical officers on the African station:

"I found bark and rum given to the men going away on duty of the greatest benefit; but, from the bulk of the bark, and the small quantity of the rum, if the men were not watched closely, they would not take the draught at all. All that could be desired is now obtained in the medicated wine."

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Eighteen men were detached in the pinnace and whaler to cruise off Banda Point and Mayamba Bay, in the months of February and March. They were absent for twenty-four days. I directed an ounce of quinine wine to be given daily to each person, and it is satisfactory to state that no sickness whatever occurred."

"Two boats' crews have been constantly on detached service, close in shore, where the effluvium, wafted from the land by the morning breeze, is very offensive, and highly pregnant with the odour of decomposing vegetable matter. The immunity from disease of those engaged in this service, I attribute chiefly to the regular use of quinine wine and bark together with protection by good awnings."

"The boats remained in the Pongas one night, and the crewsofficers and men amounting to twenty-four in number,-were exposed to the sun the greater part of two days. Quinine wine was given in ounce doses for eight days afterwards, and I attribute the exemption of the greater part of the people from fever to its use."

It may be stated, that these extracts afford no proof of the preventive influence either of bark or quinine beyond the opinion expressed by the several reporters; but when taken in connexion with those which follow they appear in a different light, and form a kind of presumptive evidence which cannot well be rejected.

"During the time the boats were up the Scarcies, I gave an ounce of the solution of quinine to each man daily, and continued it for ten days afterwards; and although the rains were commencing, and the men were often wetted through, I had not a case of illness."

"The boats were frequently away cruising in the mouths of the rivers, or else blockading the coast between Delagoa Bay and Mozam