consequently enemata were administered, which were each composed of 1-20 of a grain of alcoholic extract of nux vomica, and two to four grains of sulphate of quinine, with a small quantity of camphor in starch mucilage. The above enemata were repeated every two hours until six or eight had been given. This treatment having proved successful, it was carried out as regards twenty other cholera patients. With the majority a sensible improvement took place, and typhoid symptoms were completely wanting. "The reason is simple," said Dr. Everard; "after an attack of cholera, there is great irritability of the stomach, and to introduce irritant medicines into it may induce prostration, and even gangrene. In the treatment of those grave fevers which prevail in the Caucasus, sulphate of quinine is given in enormous doses, and yet it very often fails in its effect. I think that in those cases, as well as in cholera ones, the stomach is too much injured to derive benefit from this remedy; therefore it would be preferable to introduce it by way of the rectum. I trust that the experiments which will be carried out in those regions will soon confirm the result which I expect."

Such experiments I have made, and they have proved to me that small doses of quinine, repeated at short intervals, succeed better than large doses given at longer intervals.

YELLOW FEVER OR BLACK VOMIT.

This fever is likewise of miasmatic origin. It prevails chiefly in South America, at the mouths of the great rivers.. Its invasion is announced by a violent headache, a feeling of universal uneasiness, with lassitude, general prostration, and alternations of shivering and dry heat. The face is red, and the eyes blood-shot; the tongue, especially at the edges and point, is at first red and dry, it afterwards is loaded with a yellowish coating, which, later on, becomes brown; deglutition is difficult; the epigastrium is tight and painful; obstinate

vomitings supervene, the vomited matters being at first bilious, and then black; severe colics occur; and the stools are liquid and fetid, in the first instance bilious, but soon becoming black. Symptoms of ataxy ere long appear, and the patient at last dies exhibiting all the phenomena of a putrid decomposition.

These symptoms prove that the disease is produced through a violent poisoning of the system. To bleed would avail nothing, since it is the blood which is decomposed. The utmost that may be attempted in that respect, is to apply leeches or cupping-glasses (as derivatives) over the points most menaced.

As in cholera, the bowels should be immediately acted upon by Seidlitz salt, dissolved in acidulated lemonade, so as thoroughly to wash out the intestinal tube, and arseniate of cafeine, sulphate of strychnine and hyosciamine should be administered to calm the spasms of the stomach, and relieve the cephalalgia:-

A granule of each, together, every half-hour, during the intervals of vomiting.

As soon as the reaction commences to take place, it must be maintained by quinine (arseniate or hydroferrocyanate) :A granule every half-hour.

If the temperature remains at 40° or 41°c., aconitine and veratrine must be given :

A granule of each, together, every half-hour.

The above is the treatment which has been put to the test in Brazil, by a physician who was so fortunate as to conceive the idea of introducing into that country the Dosimetric system, and who has published an account in the Répertoire of the results obtained by him. The results could not fail to be favourable, since the treatment was directed at the same time against the cause as well as the effects (symptoms) of the disease. (Vide Manuel de la Fièvre.)

TYPHUS FEVER.

Typhus is an adynamic and ataxic fever, due to an animal miasm; therefore it is observed to break out wherever there is over-crowding-in hospitals, prisons, camps, and on board ships. Fatigue, deficient and bad nourishment, and demoralization, tend to increase its ravages.

The general stupor; the fixed and dull eyes; the decubitus de plomb; the prostration so extreme that the patient is unable to turn in bed; the troubled dreams; the dull and muttering but sometimes violent delirium; the coma-vigil; the dusky flush; the muscular tremblings; the fetid breath and defecations; * the mottlings and mulberry spots; the petechiæ; the typhus odour; the black crust on the tongue; the sordes-covered lips and teeth; and the hæmorrhagic transudations, all indicate decomposition of the blood.

The proper treatment of typhus is suggested by the consideration of all these symptoms: therefore, from the commencement of the attack, the Seidlitz salt must be given to wash out the intestines, and continued until the mouth is cleaned and the stools have ceased to be fetid. This may be effected by the administration of the following beverage, of which the patient may drink a wine-glassful every hour:—

Seidlitz salt, one tablespoonful; infusion of elder flowers, 20 ounces; syrup of lemon, to sweeten.

In the intervals, the patient must take arseniate of strychnine, veratrine and arseniate of cafeine :

A granule of each, together, every quarter-of-an-hour,

for the purpose of opposing the adynamic and ataxic condition.

* As a rule, the bowels in typhus fever are costive-still, it is not unusual to meet with many cases where diarrhoea is present-the stools being black.

The reaction having been established, as shown by the recovery of the pulse, it must be sustained by quinine (arseniate and hydroferrocyanate) :—

A granule of each, together, every half-hour,

until the temperature ceases to vary at different hours of the day. It is seldom this temperature then exceeds 39°c..

However, should it rise to 40° or 41°c., veratrine with aconitine must be given again to moderate the caloric and calm the nervous symptoms.

The Seidlitz salt should be administered every morning:A tea-spoonful dissolved in a glass of water, so as to cleanse the intestines.

As the principal drink, nothing is better than fresh water, for which the patient is very greedy, but it should only be given in mouthfuls, so as not to introduce too much water into the blood, and to avoid, besides, the production of disorders of the urinary passages.

If the urine should continue scanty and ammoniacal,. digitaline must be given:

A granule every hour, alternately with aconitine and veratrine, if the latter still be required.

The patient will require to be nourished as soon as possible, so as to combat the extreme debility. Therefore, spoonfuls and mouthfuls of good soup and old wine* must be frequently

* Wine, in common with other alcoholic stimulants, should be administered with extreme care, and prescribed in measured doses by the physician alone. Unless there are special indications,-such as failure of the heart's action, and falling of the temperature below the normal,-it is better in most cases of fever to trust chiefly to good soups, milk, koumiss, and other easily-assimilated foods. If a wine is indicated, perhaps the St. Raphael is the best. The Spts. ammon. arom. and Ammon. carb. are also reliable stimulants. A rapidly-falling temperature may often be arrested and vitality restored by the administration of strychnine (arseniate or sulphate), phosphoric acid, and benzoate of ammonia :

A granule of each, together, every quarter-of-an-hour till the temperature becomes normal.-H.A.A.

given. Thanks to the above treatment and regimen, the fever will be cut short, instead of being allowed to run over its septenaries, as it does when the expectant method is followed, or commonplace prescriptions are adopted.

From the moment it is admitted that typhus is a paroxysmal fever (fièvre d'accès),—and there cannot be any doubt of it in this respect, because between the morning and evening temperatures there is a difference of 1° to 11⁄2°c., and the patient experiences alternations of shivering and heat,—it must be treated as such, the defervescent alkaloids and antiperiodics being employed. Strychnine (arseniate) is necessary from the very commencement of the fever, because the prostration is so great, and it is needful above everything to maintain the vitality.

That typhus can be jugulated, I believe to be a demonstrated fact, for I have often had to treat such affections during my hospital career. It even has happened that I have received patients who had entered on the second septenary, in whom the facial dulness and the muscular tremblings gave me cause to fear that already the meninges were attacked. Thanks, however, to arseniate of strychnine, arseniate of cafeine, veratrine and digitaline, according to the symptoms, it was rarely that the latter did not amend and gradually disappear.

Seeing that at the commencement of this work I pointed out that the physician is the minister of nature, it is therefore necessary that he should render her assistance. It is in moments of urgency that an energetic medication is most indispensable.

TYPHOID OR ENTERIC FEVER.

Typhoid fever is caused by a specific poison, probably of an animal character, but entirely distinct from the typhus miasm. This peculiar poison is generated spontaneously in sewagematter, and in other animal matters which are in a condition of putrefaction. It is essentially a drain-poison. Typhoid,

B