turmeric paper were unchanged by it. The cases in which this alteration of the blood occurred were attended sometimes with passive hæmorrhage from some organ, as the urethra, the anus, the nose, &c. or with extravasation into the cutis, forming extensive ecchymoses, or into the subcutaneous cellular tissue.

This morbid phænomenon is not peculiar to these diseases, and, as we have already seen, can be produced artificially in the lower animals; it always, however, occurs under certain circumstances under circumstances which are commonly supposed favourable to the developement of putrefaction, such as exposure to marsh effluvia; contagion of certain kinds; residence in cold, damp, dirty, and badly-ventilated apartments, or where many persons are crowded together; to emanations from the debris of animal or vegetable substances; to the absorption of putrid matters existing in the body itself, as in inflamed veins, and the contents of certain abscesses, to inflammation of an organ, or a series of organs in old people, or in those debilitated from poor living; to great mental and bodily fatigue, &c. It is not necessarily attended with fatal symptoms, nor does death usually follow its developement; and, strange as it may appear, it is more commonly found in diseases observing a perfectly intermittent type, than in others where the type is more continued. During the longest and best-marked intermission this alteration of the vital fluid exists; and though the patient, strictly speaking, cannot be considered in perfect health, yet he is seen walking in his chamber and is free from any symptom to which we can attach.importance; debility and a slight degree of irritation of the stomach being those observed in the generality of such cases. examine the secretions, particularly the urine, we shall, however, perceive that they differ from what they are found to be in health. If during the preceding paroxysm the patient had passive hæmorrhage from any organ, it is generally observed to subside with the vascular commotion, though not always. In many instances the intermission continues for a space of thirty-six hours, during which period blood drawn from the arm is in the state in which it existed during the paroxysm; it is liquid. This diseased state of the blood alone, therefore, is not to be considered as the febrile cause.

If we

We are entirely ignorant of the peculiar change which the blood in these cases has undergone. It has of late been attributed by a very clever author, in a work on this subject, to a deficiency of the saline particles; this opinion is purely gratuitous and hypothetical. I cannot from my own knowledge deny the existence of this deficiency; but admitting it to be the case, the nature of the alteration still remains unexplained. The blood in the majority of the cases was unchanged, at least it was impossible to distinguish any difference in its appearance from that which it possesses in health, except where it presented the inflammatory crust. The only cases in which I have ever seen this change are those related; we cannot therefore form a correct idea of the proportion in which it occurs from its apparent frequency here.

Heart and Appendages.

The pericardium was usually found in its normal state. In many cases the heart had undergone no change whatever; in others the consistence of its structure was totally diminished; in none, however, was this so great as has been described by certain authors, nor even so great as it is frequently seen to be in some other diseases. It was occasionally, however, soft and flabby, as I have just said; its colour being either natural or unusually pale; but I never saw its texture so altered as to admit of being torn by the finger without employing considerable violence. No alteration in its volume was observed, or if any difference in this respect did occur, it existed independently of the fever. Viewed internally in one case, inflammation of the lining membrane seemed to have existed, as the ventricle and auricle contained a fibrinous exudation, which had become organized.-In another the lining membrane of both cavities was of a rosy redness, this colour extending into all the large vessels, particularly the aorta, which presented several rosy streaks and patches along its whole course, as far as the division into the iliacs. The same appearances were observed in one or two other cases, but as there was neither false membrane nor a gra

nular aspect, without which the strict pathologist will not admit the existence of previous inflammation, I content myself by mentioning the occurrence, without insisting upon the cause; and I do this the rather as these appearances are comparatively rare. In all these cases the blood was found liquid.

Encephalon and its Connexions.

After gastritis and enteritis, in point of frequency, comes meningitis. Out of the twenty-six cases it occurred in thirteen, and in the eleven others it was observed four times, or in seventeen cases out of thirty-seven, being a proportion of nearly one to two. The dura mater was never found affected; its sinuses, however, were occasionally engorged. The arachnoid presented different degrees of inflammation, from simple milky opacity with very slight thickening, to gelatinous infiltration and exudation, in some of which cases in certain places it was a line in thickness; the pia mater, from simple increase of vascularity, presented all the degrees up to sanguineous infiltration. In many cases the membranes were equally affected on the surface and at the base, whilst in some the inflammation was greatest at the base, and in others on the surface. Sometimes the arachnoid appeared to be studded all over with beads of lymph, in which the commencement of organization was observed. Except where an effusion of bloody serum separated the arachnoid from the pia mater, these membranes were firmly adherent, and when removed from the brain and held between the eye and the light, they gave the appearance of a finely injected tissue, or the wattles of a cock divided vertically. This depth of colour was dependent upon the extremely engorged state of the capillaries of the pia mater. In one or two cases the arachnoid itself was observed to be vascular, but this is a rare occurrence.

Rochoux observes, in his work on the yellow fever of Guadaloupe, "that the membranes of the brain were rarely so severely affected, or presented such traces of inflammation, as are seen in subjects in Europe." My experience leads me to a different opinion; it is not only more common than in

Europe, but is much more pronounced in its pathological character, it being understood as occurring in both cases as a sympathetic læsion. Effusion into the ventricles was common, but in few or none of the cases was the choroid plexus redder than usual; on the contrary, it generally possessed a macerated and pale appearance.

In a few cases the cerebral mass appeared somewhat firmer than natural, and in a state of active hyperhemia; in one or two it was evidently in a state of inflammation throughout its extent. The surfaces of the convolutions immediately underneath the portions of the pia mater where the inflammation was most intense, were usually found red, softened, and converted into a sort of pulp; this læsion, however, was superficial, being confined to the surface, and seldom exceeding half a line in depth. The cerebellum was almost invariably sound; in one case it was somewhat indurated, and the convolutions developed, but this did not appear in any respect connected with the disease which proved fatal.

SYMPTOMS.

One of the greatest errors committed by authors in describing the disease before us, is the compilation of symptoms from a variety of cases, and the huddling of them all up together. Such attempts have been always attended with a failure, and have led the general reader into serious mistakes respecting their nature; for there is no class of diseases which presents the character of individuality so strongly contrasted with the great variety of phænomena exhibited by each case as this. In this way the nervous and ataxic symptoms have been con founded with the gastric, or both these have been but slightly regarded, while great stress has been laid upon the engorged state of the lungs and liver, læsions which, as we have seen, are of rare occurrence. The only correct means we possess of studying these different modifications is to examine attentively every case, and then to describe the symptoms peculiar to each læsion. If we were to adopt an arrangement founded upon the type alone, our arrangement would be as voluminous

as our cases are numerous. Το prove this we have only to look at all the varieties and irregularities which occur between a pure intermittent and a continued fever. For these reasons I have divided the symptoms according to the organs affected, and shall proceed to take them in their proper order.

Symptoms connected with Læsions of the Stomach and lower portion of the Esophagus.

When we are called to a patient a few hours after the commencement of his illness, we in almost every case find him lying upon his back, often with his arms crossed over the chest, or with a pillow pressed closely against the epigastrium. In a few seconds he flings himself to the side of the bed, or tosses his arms about here and there, apparently in search of refreshing coolness. Though this agitation may be said to be almost continual, yet we find that the patient seldom lies in any other position than on his back; or if he do for a moment, he immediately turns to his former one. In this way he is seeking relief by change of place, or venting his impatience by the agitation of his arms, and by bending and extending his legs. This state of agitation is greatest in patients of a nervous temperament, and is not in them for the most part a symptom of great danger, whereas supination, particularly if it be protracted and be accompanied with moaning, frequent sighing, crossing the arms over the chest, or pressing a pillow upon the epigastrium, has at all times been considered as indicating a great degree of suffering in the stomach. Amongst other symptoms, the patient is sometimes troubled with a short dry cough, particularly when the nausea is great, or immediately before vomiting; it is unconnected with any irritation of the respiratory organs, and has therefore received the name of stomach-cough. It is sometimes a distressing symptom, but does not indicate any particular increase of danger.

If you ask the patient how he feels, he will probably answer that he is very ill, and complain of his head, back, and