cidedly more salubrious. Had the man remained in the South, it is more than probable he would have escaped the severe attack which nearly destroyed him.

The case teaches, moreover, that whenever the evidence of the paroxysm is vastly above the ordinary grade of intermittents, we can scarcely give too much of the sulphate during the intermission. To the same point, is the testimony of Dr. Flint, of Buffalo, and the army surgeons, as reported in the journals. So that, if we never know what is the essence of periodicity, we know what is far more important, viz., the practical fact, that sulphate of quinine is the grand anti-periodic, with which no other agent can be compared, but to be consigned to insignificance. That the action is, somehow or other, on the nervous system, through the stomach, we cannot doubt, although we have no positive knowledge in the premises.

We may also cite the case reported by Dr. Corbin, of Virginia, in Dunglison's Medical Intelligencer, of August, 1841: it has a very direct application.

The

The patient had an ague of eighteen months' standing, that had re. sisted various remedial efforts. Dr. C. applied a blister to each extremity, and one over the epigastrium, an hour before the expected parox. ysm. To the denuded surfaces, an ointment was applied, made by rubbing five drachms of the sulphate of quinine with four ounces of simple cerate. The whole of this was spread on cloths, and laid on the blistered surfaces, eight hours after the blisters had been applied. These dressings were not disturbed until the parts had healed. result was a perfect cure, and that, too, without a single inconvenience. But let us turn our attention to the agency of this medicine, in the treatment of remittents, from the mildest grade up to the severest form, usually called yellow fever. The extracts from my paper of 1825 show the success of the sulphate in mild and more aggravated cases. In this region of country, I have put the same medicine to the test, most tri. umphantly, in the cases of medical pupils, who were brim-full of typhoid fever notions, and who sent for me to manage them, for that disease. Several cases of this kind have fallen under my care. The first saluta. tion, on entering their chambers, was, "typhoid fever." I laughed at the idea, and annihilated it, as far as I was able, treated the patients vigorously with the sulphate of quinine, and had them in the lecture rooms in a week. These very cases, I feel confident, could have been made as veritable typhoid fever specimens as are to be seen every where in the West.

As a palpable counterpart of the practice of many physicians, let me here refer to the Medico-Chirurgical Review for July, 1845, at p. 212. The writer treats of malarious remittents. "I found the little boy, W. J., with an ardently hot skin, face almost scarlet, sharp pulse, too rapid to be counted, and delirium; in fact, every symptom of fever, so intense as, in the minds of some of the pupils who were with me, to justify most active antiphlogistic treatment; and yet, the next morning, a remission having occurred, he bore the sulphate of quinine, in two. grain doses, and in five days was convalescent."

Again: "When the remission was not very distinctly marked, an emetic generally seemed to produce this effect; and then the sulphate was given, and invariably cured the disease,"

In the New Orleans Medical Journal, vol, i,, a writer (Dr. Beugnot) speaks of a syncopal remission, induced by copious bleeding in the onset of yellow fever, after which the sulphate of quinine was eminently successful.

I have long since maintained the doctrine of cutting short febrile diseases, and I am daily more convinced of its truth. My own experi ence in the use of the sulphate of quinine in remittents, as reported in 1825, contrasted with the eight weeks' treatment of those who adopted an inefficient course, is amply to the point, to convince any reflecting and unprejudiced man. The case reported by my son, in which 240 grains of the sulphate were given, successfully, in four hours, is evidence wholly irresistible. But for that rigorous treatment, the man would probably have died in the next paroxysm. The means adopted cut short the disease, as certainly as you snap a pipe-stem into two pieces when you break it in the centre. The very fatal yellow fever kills ordinarily in three or four days; but if, by proper treatment in the first twenty-four hours, I save the patient, what do I effect, but the sudden arrest of the febrile attack? If the man is saved at all, it is, for the most part, by what is done in the first twenty-four hours.

Well, but, says one, how would you cure a case of typhoid fever, even conceding your views of its remittent nature, after the lesions of the small intestines were established, or, in other words, dothinenteritis set up? Would the sulphate of quinine be successful then, and if so, how? To this I respond, that the query embodies an assumption which I do not admit, because it is absolutely without proof. I know there are some men who, on finding such lesions in the small bowels of a subject in a dissecting-room, of whose history they knew not an iota, would swear, that typhoid fever had killed the patient. But I am not quite so highly enlightened as these gentlemen, and do not pretend to see quite so far: yet I do honestly believe, that the bowels may be the subject of exactly such lesions as are made, by some, infallible proofs of typhoid fever, where not a symptom of that disease, as recognized by its special advocates, had existence. I have said, that I had seen precisely what is now called typhoid fever more than twenty years ago, in the hands of men who had very badly managed the prevalent remittents, and I say so now. It is my abiding conviction, from experience and observation, that nine-tenths of the cases called typhoid fever were curable in the first week, by the sulphate of quinine, properly administered. If the favorable period for its administration be wasted, as I know it often is, and the patient harassed and worn out, either by irritating cathartics, or by a do-nothing policy that allows the secretions from the bowels to become depraved, and inflammation and ulceration to follow, thus in volving the patient in a sympathetic fever, that might have been prevented by an early resort to proper means, I have only to say, that I cannot thank any man for the honor of calling me to his aid, as consulting physician in such a case. For the very same reason, I have often refused to take such cases when then the attending physician had been discharged, or had discontinued his visits.

It would be no difficult task to cite many authorities, in proof of the efficacy of the sulphate of quinine, in what was called typhoid fever, by virtue of its anti-periodic power. The cases were truly remittents, and

the remedy succeeded because it annihilated the periodicity. Doctor Waton, of Montpelier, in France, and Dr. O'Brien, of Dublin, who speaks of Typhus instead of Typhoid, in this relation, are in point. Dr. Kennedy, of Ohio, whose letter was republished in the Western Lancet, of August last, is equally forcible, and the whole, with many other proofs, equally cogent, are corroborated by my own experience.

And then, let us bear in mind what mischief has been done, by dissociating the idea of typhoid fever with the doctrine of remission, and abandoning that disease to the expectant plan of treatment. The names of physicians could be given by the score, who can see nothing but typhoid fever in any case, if it be a febrile attack, in any sense; and, as a consequence, they overlook not merely the more obscure remissions, but even palpable intermissions, and treat, not unfrequently, with blue mass or nothing, cases that imperiously demand the interposition of the sulphate of quinine. To such gentlemen, let me say, that the fevers of the United States are essentially periodical; and, if you would treat them successfully, the doctrine of periodicity must never be forgotten; no, not for an hour.

A few weeks since, a very intelligent graduate of Transylvania, who has been engaged in active business some eight years, detailed to me several cases, fully confirmatory of all that is stated above. He assured me, that in his region, the physicians can see nothing but typhoid fever, go where they may. Their practice is actively cathartic for the first three or four days, and then the cases are left pretty much to nature. He avers, that under this delusion, cases of pure intermission, calling loudly for the sulphate of quinine, are often mismanaged, and that remit. tents are constantly treated on the same erroneous principles. The proper time for the salutary action of the sulphate of quinine is thus lost, the bowels having been needlessly irritated by repeated cathartics, the strength wasted, and no recuperative means attempted, the patient sinks, either from the debility induced, or from a sympathetic fever set up by lesions of the small bowels, it may be, which, if seen after death, are put down as the cause of all the mischief, when, in truth, they are frequently the legitimate fruits of bad management, and had no agency in the production of the original fever.

I am not unaware of the argument in favor of the totally diverse character of what is called typhoid fever, typhus and remitting fever, based on alleged symptomatic and post-mortem differences. But I should like to be told, what all these diversities amount to, as an argument for dissimilarity in essential nature, that will not, with greater force, operate to make the mildest form of scarlatina, the malignant variety, and that in which every stereotyped sign of the disease is absent, separate and distinct diseases, rather than mere varieties of scarlet fever. There are practitioners in Lexington, who hold to the doctrine of specific difference between typhoid, typhus and remitting fevers, who, a few years since, pronounced several cases to be real scarlatina, in which there was neither cutaneous nor anginose evidence to justify such a decision, and their opinion rested on the naked fact, that scarlet fever had recently been prevalent. Nor were those physicians singular in this matter, for the very same thing can be found in some of our standard works.

We feel as confident, as of any other position, that all fevers, not

characterized by obvious local lesion, are mere varieties; and that in all, periodicity can be detected, and is the most tangible basis for successful remedial efforts. We mean just what we say, and are content to take pure typhus, as a case in point. We know that, by many, this is regarded as a bona fide, continued fever, in which, of course, there are no remissions, and consequently, no periodicity. But this is precisely what we deny; and although we have seen a good deal of this true typhus, in early life, we prefer, in order to escape cavil, to rely on authority that cannot be called in question.

The Dublin Medical Transactions contain the fullest and best history of typhus fever that has ever been recorded, and we rely on its statements, on the present occasion. In the fourth volume, we find an excel. lent paper by Dr. O'Brien, from which we shall make some extracts. "In two cases," says the Doctor, "the effect of the sulphate of quinine was decisive, and the recovery as rapid as in intermittent fever. In three cases, the result was less rapid, but not less effectual. The patients improved gradually, and ultimately recovered, without relapse." (P. 370.) "The rapid recovery effected by the medicine (the sulphate of quinine) in both cases, excited a suspicion, that the fever was of a remittent type." (P. 374.)

Let it be borne in mind, that Dr. O'Brien is writing the history and treatment of Irish typhus, recognized as such by all his professional brethren, and by many attributed to contagion. Indeed, the faculty there seem, for the most part, to be wholly ignorant of intermittents or remittents, excepting as matters of history.

Again: "There is reason to believe, that the important class of remittents has been too much overlooked and disregarded in this country, and, by a loose and general classification, confounded with typhus." (P. 376.) "With respect to the stage of fever most appropriate for commencing the sulphate of quinine, the period of direct debility or collapse appeared to me the most suitable." (P. 377.) It is quite easy to understand, if we reflect on the almost total want of familiarity with remittents in practice, that the period of direct debility spoken of, was the period of remission.

Can it be matter of astonishment, that the physicians of America 'should regard typhus fever as a positively continued febrile affection, with no remission, when the medical men of Ireland, who have seen so much more of the disease than any others of the profession, have almost uniformly fallen into the same error? We are too much the slaves of fashion in these matters; and in the face of all the fashion, here and elsewhere, I affirm that there is not and never was such a thing as absolutely continued fever, without remission, for five days, in unbroken succession. It is not in the nature of the human economy, nor of dis. case, to have such morbid persistence. Remission, more or less perfect, is a law of nature, and may be detected, with care, in what are called typhoid and typhus fevers, just as certainly as in the mildest remittent. But the grand error lies, in mistaking the meaning and nature of remis. sion, and in looking for positive intermission in its stead, as the basis of the right use of the sulphate of quinine. Here is the rock, on which hundreds of practitioners, otherwise well informed, are daily making shipwreck. The physician perceives no obvious remission, and he takes

the word of the nurse, who perhaps was asleep more than half the night, as proof that there was no remission at all. Such is the basis of professional opinion, and consequently of professional blunders. And even though the physician remained with his patient during three whole days and nights, if he had no just views of the difference between remission and intermission, (and many have not), his apparent care would result in no practical advantage.

These doctrines could be sustained by a vast amount of testimony, if it were needful to swell this paper by so doing; but we presume enough has been said already. The subject is a favorite one, and we have been in the habit of teaching thus for years, and shall continue to do so, until new light shall discover our error.

A few remarks on the sulphate of quinine, as a sedative, and we shall dismiss the whole subject, for the present.

We have not met with facts, in our own experience, that would positively sustain the sedative action of the remedy. Some intelligent prac titioners think it acts thus, even when given in large doses, in the stage of high febrile excitement; they suppose it abates the excitement, and thus controls the morbid action. Others regard it as a sedative, when it succeeds in allaying high irritability of the stomach, as seen in ordinary remittents, and in the most malignant form, known as yellow fever. That it has acted most happily in such circumstances, there can be no doubt; and it would seem to operate then either as a counter-irritant, or contra-stimulant, or sedative. Nausea and vomiting have been arrested by it, as occurring in the more ordinary remittents, and even the black vomit of yellow fever has yielded to its potent sway.

In reference to the sedative agency of the sulphate of quinine in yellow tever, I am inclined to believe, that there is co-operative, at the same moment, the anti-periodic power. In a paper, On the Yellow Fever on board the Volage, contained in the New York reprint of the London Lancet, for March, 1846, we find the following remarks :— "Some of the German and Spanish physicians at Havana give the sulphate of quinine at a very early period of the disease, as soon, in short, as they observe any thing like a remission, and they speak favorably of its operation when thus exhibited." And again: "The sulphate of quinine was freely given, and with a success so marked, that I feel justified in recommending it as an invaluable and essential adjunct." Nor is it at all difficult to reconcile the declarations of those who believe in the power of the sulphate to allay the gastric irritability of yellow fever, with the statements of others who laud the value of the remedy, when given in the earliest remission perceptible in that dreadful malady. We have only to suppose, that the sedative and anti-periodic powers co-ope rate, to bring about the happy results.

The facts cited by Professor Harrison, of New Orleans, in his paper on yellow fever, published in the medical journal of that city, in Novem. ber last, are supposed by some, to prove the sedative operation of the sulphate. I am not able to come to a like conclusion. Certainly, the experiments of Dr. Hunt, as detailed in that paper, do not establish a sedative action. They were performed on convalescents, who, of course, were debilitated. The reduction of pulse, under the use of the sulphate, was, no doubt, accompanied by a corresponding augmentation