use of undiluted spirit, has had these paroxysms of an anomalous nervous affection, which he feels a difficulty in describing, but which is of a quartan type. I saw him 15th of Sept. 1833, at the commencement of the fourth paroxysm. Extreme anxiety is depicted in his countenance, which is pale; the lips bluish, extremely cold and livid, fear of death; sitting up in his bed; slight dyspnoea; acute pain over the region of the heart. This organ is seen beating violently and irregularly through the parietes of the chest. Pulse is rapid, irregular and intermittent; the intermittence corresponding with that of the heart, and appears to be produced by disordered innervation. The blood is heard distinctly passing from the auricles into the ventricles, which do not always appear to be influenced by its presence, as it seems to remain there without producing contraction for a short period; and when this contraction takes place it is powerful, sudden, and with a jerk. This occurrence takes place about every eighth or tenth pulsation. These symptoms commenced about an hour ago, preceded by rigor and coldness; the patient attributes them to poison administered to him by his cook, and anxiously demands relief, though he despairs of obtaining it. To take forty drops of laudanum, and twenty of the tincture of digitalis immediately. About twenty minutes after taking the draught, the patient vomited freely, and the stomach was relieved of its contents. The pain and irregular action of the heart ceased, and he found great relief; suddenly, however, he was seized with acute pain in the course of the sacro-ischiatic nerve of the right side; so great was this that he could not be moved without screaming. In a short time this pain ceased, and the former symptoms returned. I was again sent for, and administered the former draught. Relief of the symptoms followed, and towards evening the patient fell into a calm sleep. Second and third day-free from accident of any kind, but still convinced that he is poisoned. Morning of the fourth day all the symptoms returned, alternating with a colic, and the nwith the pain in the back of the right thigh. There was this remarkable, that when the neurosis left the heart and intestines, and at tacked the lower extremity, the rigors were more intense, and the sense of coldness more perceptible to the patient's feelings. Fifth and sixth day, free from complaint, and taking three grains of sulph. quinæ and a quarter of a grain of the acetate of morphia four times a day. Seventh day, slight rigor without the other symptoms. Continued the use of his pills, and returned to the estate cured. CASE VI.-A sailor, aged about 40, a month after his arrival, had a pain in the abdomen, which came on every evening after leaving off work, and continued until the following morning. This pain was so severe as to prevent his sleeping, and at the time I saw him he was considerably emaciated. A variety of medicines had been given him, but without producing relief. The patient, though tolerably well during the day, invariably became exceedingly unwell at night. January 8th, 1834, I saw him for the first time. He appears thin and emaciated, but says that I must see him at night if I wish to be of any service to him; his pulse is natural, and his tongue, though somewhat furred at the root, presents nothing remarkable in its appearance. I can discover no apparent disease in any organ. I saw him again at night, and things were indeed very different; he was shivering with cold in his bed, though covered with three or four blankets, and in an atmosphere of at least 90°; his forehead was covered with beads of perspiration, produced, he says, by the severity of his suffering; he rolls about, moaning most piteously, and pressing a pillow against the abdomen; intense colicky pains; the bowels are open; has been twice to stool in the course of the day; the pulse is natural.—To take three grains of tartarized antimony, en lavage, immediately, and early to-morrow morning a dose of castor-oil. 9th. He thinks the emetic has been of some use to him by procuring a discharge of bile both upwards and downwards, but the pain continued until its accustomed period. Evening; another paroxysm has commenced, similar in every respect to the former. 10th. To commence the sulphate of quinine. Evening; the paroxysm has returned, but is very slight. 11th. To continue the use of the quinine. From this period the paroxysms ceased, and the patient remained in a state of comparatively good health for about a fortnight, when he was again attacked with his former symptoms, accompanied by a numbness of both arms. The colic was again relieved, but the numbness of the arms terminated in paralysis of the extensor muscles of the forearm; the fingers wereflexed, and both members in a state of pronation, the skin preserving its sensibility. The patient left the island in that state. Remarks. The foregoing cases present no features of novelty under the name of concealed fevers the physicians of former days give us many such. They occurred within a few months of each other, during an epidemic of fever which attacked a considerable proportion of the population of Castries. The greater number of the cases constituting this epidemic were of a subintrant or intermittent type, and were accompanied by a considerable irritation of the gastro-intestinal mucous membrane; but there were many continued, some of which offered the symptoms said to be the distinguishing characteristics of yellow fever. Why were the cases detailed above exempt from that which was common to the rest, the hot or febrile stage? They arose, most certainly, from the same cause, and were cured by the same means as are employed in the more usual forms of intermittent. For the present it is sufficient to mention the fact; the explanation we will leave to another opportunity. To what are we to attribute these symptoms, the tremors, the spasms, the colics, the neuralgic affections, the palpitations, the diminished evolutions of caloric, &c.? Were they dependent upon the inflammation of some organs? It would be madness to suppose so. They were dependent, on the contrary, on a disordered innervation ; and we must agree with M. Rayer that the cause of this is to be found in some functional derangement of the brain and spinal marrow. What that derangement may be, our present knowledge does not allow us even to guess at. There is, however, a word already coined which we must make use of as well as our betters, I mean irritation; it certainly does not throw any light upon the nature of the malady, but it is a concise and easy way of comprising in one term the phenomena which constitute its outward and visible effects. The above symptoms we therefore say depend upon an irritation of the cere bro-spinal nervous system, caused by the operation of malaria. Cases of Intermittent Inflammations. CASE VII. Intermittent Pleuropneumonia.-Lucille, a girl of colour, aged 23, has been unwell for two or three days with what she calls a cold, but has not been confined to the house until yesterday, when she was suddenly attacked with a severe pain in her side, cough, and fever, about nine o'clock in the morning. The symptoms ceased toward evening, and she remained tolerably well until this morning, August 21, 1833, when they again returned. At noon I found her as follows: Pain over the sixth and seventh ribs on the right side, increased on inspiration; dry cough, crepitating râle over the seat of the pain; no uneasiness of the epigastrium; bowels regular; skin dry and warm; tongue natural. She had no cold stage, nor was the attack preceded by a sense of coldness. Diet-demulcent drink; castor oil. Evening; the patient is perspiring; expectoration on coughing; the pain has subsided; the râle is mucous. 22nd. The patient has had a return of the paroxysm; the pain in the side is greater than yesterday; several fits of coughing, with expectoration of sinall quantities of very viscid mucus; râle crepitant; pulse ninety-six. Evening; perspiration, and mitigation of symptoms; expectoration free; the sputa white and frothy; there is still some pain on inspiration; the pulse is eightyfour; bowels open. 23. The paroxysm commenced two hours before its usual period; I saw the patient at noon; she is much worse than she has yet been; the sound on percussion over the seat of the disease is somewhat dull; breathing very painful. Evening; the disease is advancing; there is no appearance of intermission; sound on percussion dull; centre of the diseased part does not appear permeable to air: at least the crepitating râle in its neighbourhood hides the sound, if any exists; sputa viscid, adherent, and of a rusty colour. V. S. 3 xvi.; hirudines xx. lateri; decoction of marsh-mal low, in which antim. tart. gr. vi. are dissolved for drink. 24. The patient is better: to continue. Evening; amelioration very great; great prostration from the effects of the antimony, of which the patient has taken nearly eighteen grains. 25. Expectoration free; rále mucous; pain nearly gone; pulse seventy, small. To take the medicine only now and then. 26. Convalescent. CASE VIII. The carpenter of the ship Cuba, up to this period in the enjoyment of good health, married, and father of three children, has been unwell, for the last week or ten days with pains in different parts of the body, but is laid up to-day for the first time. He says that he has a good day and a bad day. The pains first commenced in the loins, then attacked the shoulders, and are now in the left knee and ankle; the knee is somewhat swollen and warm; the patient complains of excruciating pain on moving it; the ankle is not swollen, but is warmer than natural; the pulse is ninety, and full; the tongue clean, and the bowels open from medicines which have been given to him: warm fomentations to the knee, and to take twenty drops of the vin. colchici thrice a day. The following morning: the patient is walking about; the pains are gone, and nothing but a stiffness remains. On the third and fifth days from the period of my first seeing him the pains of the knee returned, accompanied by a pain and swelling of one wrist; the paroxysms continued about fourteen hours. The patient was completely cured by a few doses of quinine. CASE IX. Intermittent Peritonitis.-A. V., aged 25, of a nervo-sanguineous temperament, superficial veins very much developed; native of the West Indies, but has resided until within a few months in France. Plunged into cold water when the body was very much heated, and shortly after eating a copious breakfast; immediately felt a general uneasiness, and vomited his breakfast; he was then seized with colicky pains of the belly, which continued nearly the whole day; in the night these pains became continued, and fever was not long in making its appearance. The following morning I saw him the patient complains of considerable pain throughout the whole of the abdomen, nausea, violent efforts to vomit, : |