that it would be apt to appear in the country. One case of trus Yellow fever, attended with “black vomit," brought from Augusta, Geo., during the prevalence of the epidemic there, I attended in this county, in the fall of 1839. This case, in my opinion, differed in essential particular, from the case of a foreigner who was attacke with our common Remittent, in October, 1842, which afterward assumed the congestive form and terminated with black vomit.

Puerperal fever occasionally occurs. This fever, I believe, is tirely isopathic with erysipelas-or in other words, nothing mo than erysipelas of the womb and its investing membranes. This w the opinion of the Father of Medicine, as appears from the following remark in his aphorisms: "If a pregnant woman be afflicted wit Erysipelas of the womb, it will prove fatal to her."-[Hippocrates: Aphorisms, sectio 5th-43. My reasons for this opinion I hope u give at some other time. Milk fever is common after acouchement but rarely attended with serious consequences. It is sometimes fo lowed by collections of matter of a milky purulent character in the mammæ, and sometimes by phlegmasia dolens. The best prophyla tic against both results is the early application of the child to the breast.

*Inflammatory affections prevail mostly during the winter months Those of the head are extremely rare. I have only met with one case of acute inflammation of the brain or its investing membranes and this occurred in a child about three months old. It terminated in effusion of water within the cranium.

Inflammations of the respiratory organs are most common. Cro in its inflammatory form is rare. Laryngismus stridulus is the affec tion mostly known among us as croup. Pneumonia, bronchitis and pleurisy are here, as almost every where, of frequent occurrence in relation to other diseases. Gangrene of the lungs sometimes occurs.

Acute inflammation of the abdominal organs is not very common. Acute hepatitis is, in my opinion, far less common than it is general ly supposed to be. Functional disorder is frequent, but I have rarely met with any violent acute form of disease that could be referred with certainty to the liver as its primary source. It seems to be an universally entertained opinion, that in hot climates the liver must be often diseased; but according to my observation, that organ is

I use this term as commonly understood, without pretending to endorse the correctness of its application to the many different diseases included under it.

often blamed for disorders of which it is entirely guiltless. Dr. Johnson's works on Tropical Climates and Diseases of the Liver, are, I fear, somewhat of a libel upon both topics of his very fertile and ingenious pen. Were intoxicating drinks, the use of opium and tobacco,* the immoderate eating of animal and vegetable food, and more particularly the former, entirely abandoned, and people to live with a strict regard to temperance in all things, the liver would no doubt perform its functions with as much regularity and certainty as any other organ in the body-and the equable and balmy air of the tropics would be redolent of health. For my own part, I cannot see why the liver has been so much singled out by authors as the strong hold of disease, as it were, and so many articles of the Materia Medica collected together under the name of Cholagogues for its especial benefit. Every young practitioner is for the most part directed to look to it in almost every case, and he begins his career with the "Sampson" of the Materia Medica as the ground of all his hopes, and whenever put to it to tell, in obstinate cases, what is the matter with his patient, clothes all his misgivings in the sapient reply, that it is Chronic Hepatitis.

A paralysmic state of the liver and spleen very frequently arises as sequelae of intermittents when long continued, and should no doubt be treated in a similar manner. They are of far less common occur. rence now than formerly, which is to be ascribed, I think, mainly to the fact that blood-letting is not pushed to so great an extent, and quinine earlier resorted to, in the treatment of this fever now, than it was even a few years ago. It is but just to remark here, that the "observations" of Dr. Wm. C. Daniell "on the Autumnal Fevers of Savannah," published nearly twenty years ago, contain the first efforts that have been made to introduce a practice in our autumnal

mours.

* Excess in eating and drinking is injurious to health in three different ways. It immoderately strains and thereby weakens the digestive organs; it prevents digestion, since it is impossible that in so large a quantity every particle should be digested properly, and it produces crudities in the colon and morbid huFinally, spirituous liquors, of whatever name they may be, must, by all means, be considered as substances that shorten human life. They are a liquid fire, accelerate the consumption of the powers of life in a fearful manner, and in fact transform life itself into a process of combustion. Moreover, they create cutaneous diseases, aridity and torpor of the fibres, premature old age, cough, asthma, pulmonary complaints, and-what is worst of all—an awful dullness and insensibility, not only with regard to physical, but also with regard to moral impressions.—Hufeland Makrobistik, 2d; 39, 44.

fevers, which in a modified form is beginning to be universally adopted.

Bowel affections are among our most ordinary diseases, but in most cases may be traced, I think, to errors or irregularities in diet, indi. gestion and dyspepsia, and rarely call for medical aid; but I think the former is common, while the latter is rare. Cholera morbus, diarrhea and dysentery, most commonly arise from acrid or unwholesome food or drink. The latter prevailed to some extent in 1827, in the form of a local epidemic, and was very fatal. This was, however, before my admission to the practice of medicine, and I know very little about it. Cholera infantum sometimes, although rarely, occurs and generally terminates in marasmus.

Inflammatory rheumatism is not frequent, but the neuralgic form, or what is known as chronic rheumatism, is more common. Gout is rarely met with, and probably will be unknown to the coming generation. Calculous affections are extremely rare-I have never met with a case; and I have never heard of a case of stone in the bladder within the limits of our county. Phthisis pulmonalis or consump tion, is also very uncommon among our native population—I have only seen three cases among the whites, and about the same number among the blacks, during the course of fifteen years. Scrofulous enlargement of the lymphatic glands, however, is frequently seen among the latter. This seems to indicate that our climate is not favorable to the development of scrofula in the internal, but rather in the external organs, for I hold scrofula and tubercular consump tion to be truly isopathic affections.

Two or three cases of Goitre have come to my knowledge; but surely the remark of Juvenal, in reference to the Alps, has no application here

"Quis guttur tumidum miratur in Alpibus."

Of the cachexies, however, among the most familiar to us may be enumerated cachexia africana or dirt-eating, and dropsy. My reading and observations in regard to the former disease have led me to the following conclusions:-The eating of earthy substances has at all times prevailed to a greater or less extent among certain classes of men. Celsus distinctly alludes to it as a cause of disease in his day—“Quum diu color sine morbo regio malus est, hi vel capitis doloribus conflictantur vel terram edunt."-[Medicina, lib. 2.]-and Baron Humboldt mentions it as being common among certain tribes of American Indians, as well as other people in various parts of the

world.-[Personal Narrative passim.] Among the negroes here, I believe it to be a very common habit, and one that is taught them from childhood. I remember to have eaten clay myself when a child from the example which was set me by negro children.

It does not appear that the habit is necessarily productive of ill consequences. This was the observation of Humboldt in regard to the Otomacs and others. Among us, I know that it does not in most cases bring on disease. It is, in my opinion, almost universal among negro women who are in a state of pregnancy. I have seen places in the fields where the clay has been recently dug at by their fingers for the purpose of being eaten. I have also known a pregnant female to eat chalk in large quantities, and declare it to be a most delicious morsel. In such cases, the desire no doubt arises from demand on the part of the system for inorganic elements, and more particularly lime, and should be gratified in a proper way. If birds are entirely deprived of all substances which contain lime, their eggs will be soft, as I have observed to be the case with fowls that have been long kept in a coop, and I have seen them, under such circumstances, eat pieces of mortar thrown into them with the greatest avidity.

The disease connected with dirt-eating is evidently chlorosis. It is for the most part confined to females, and appears to arise from mal-assimilation and defective hæmatosis, whereby the blood is nearly deprived of its coloring matter, although the relative proportion of albumen and fibrine is in a great degree preserved. That this disease may be brought on by eating clay, when indulged in to too great an extent, I will not deny; but it is certain that I have seen it when the fact of eating it could not be proved, and indeed where the probabilities were strongly against the suspicion. It is certain, however, that the disease, when it occurs, is always aggravated by it, and that it should be prevented if possible.

I believe the disease to be curable-and I will here depart a little from my plan, and give the treatment, which I believe to be best adapted to its cure. In all cases, if the patient is young, and the pulse and state of the system will allow it, I begin the cure by bloodletting. In two cases I bled the patients from six to eight times in the course of two or three months, taking away from half to one pound at a time, and when I commenced, the blood would hardly have reddened a white handkerchief. My object in doing this is not to subdue inflammation, but to remove from the vessels an impure fluid,

which is not blood, so that the system may have a better opportunity of making good blood. The blood-letting is intended to act the part of a vascular cathartic. My next object is to stimulate the digestive organs to the proper performance of their functions, and this I believe to be best accomplished by occasional mercurial cathartics, and the continued use of the sesquichloride of iron-a preparation which is not found in the shops, but which can be very easily made. The diet should be generous, and consist of such articles as they fancy most.

Dropsy, as stated above, is very common, and appears in the forms of hydrothorax, ascites and anasarca. A great proportion of the older negroes die of this disease. In the young it sometimes occurs, but in them it is almost always curable. From the result of one case recently under my care, I beg leave here to suggest an early resort to paracentesis in cases of ascites in young persons.

Passing over some other affections, which are either common every where, or too rare to be regarded as peculiar any where, I would conclude this brief sketch by a few observations in regard to the Surgical, and Obstetrical practice of the county.

Surgical cases are of extremely rare occurrence-I know not whether this is to be attributed to the want of subjects, or to the want of confidence in the art itself, arising from the small number of striking cures that have been performed among us by its aid. Some few cases of dislocations or fractures, call for surgical interference, and occasionally a small encysted or sarcomatous tumor has to be remov ed, or a limb to be amputated-omitting these and such-like, I beg leave to record the following cases, which have occurred in my practice:

The first was an operation on both eyes, for cataract, by depression or couching, in the case of a negro man about 80 years of age. The instruinent used was a No. 6 or 7 sewing needle, which I ground to suit myself, and then fixed into a handle. The case terminated favorably. The second was a case in which I extirpated the right mamma for a carcinomatous affection. The wound healed readily, and the patient appeared to be well for one year, when the disease returned, and although removed a second time, the woman died in six months after. On the 2nd March, 1843, I divided the tendo achillis for talepis equinus, and applied an apparatus of my own construction upon the principle of Stromeyer's. The operation has been as successful as could have been expected. The last two cases were both hydarthrosis of the knee joint; in the first of which I operated