The face is either pale and ghastly, or becomes flushed with a purple or leaden hue, indicating capillary congestion, and imperfect decarbonization of the blood. The skin is either hot and dry, or moist and cool; the tongue rough and of a purplish color, with the mouth moistened with viscid saliva. The countenance is expressive of anxiety, agitation, and great suffering; the eyes are often suffused with tears, and the conjunctivæ bloodshot. Pain in the back and limbs is constant, severe and wearisome. Distressing nausea is common, with occasional vomiting of viscid and acrid secretions. The bowels are constipated, but the patient often discharges the watery secretions of the large intestines without relief. The action of the kidneys is defective, and sometimes wholly suspended. Delirium is often superadded to all other distressing symptoms, and this sometimes amounts to maniacal ravings.

This graver kind of paroxysm having been passed, with all its painful concomitants, there comes on a remission, which generally occurs early in the morning, and is of short duration. The most reliable indication of its approach is to be found in the pulse, which becomes less frequent, and fuller. All the more distressing symptoms are, indeed, mitigated in violence, but another paroxysm quickly supervenes, sometimes within an hour; and unless some relief be secured by treatment, it will prove to be more

painful and distressing than the previous one. The stomach will now be likely to show increased signs of disorder, while the pain and constriction of the head may be lessened. The extremities become cool -sometimes quite cold-to the touch, while the patient complains of heat, and is impatient of warm applications to the surface. There is cutaneous congestion, cold sweating, and comparative insensibility of the skin, and also excessive thirst. Great restlessness exists without acute pain, and wakefulness without mental excitement; and there is evidently much suffering without the ability to designate any particular location of pain.

The remission comes again, and almost invariably in the early morning hours. After turning and tossing during the livelong night, racked with indefinable pains, and tormented by restlessness and inability to sleep; after having been kept half-delirious by fever, and perhaps been constantly vomited and purged by injudicious medication; the patient gains a partial respite from suffering as morning approaches, and exhausted nature finds repose in sleep. There is then at last a remission of the fearful disease. The nurses, exhausted by labor and watching, gladly avail themselves of this opportunity to rest, and at such a critical moment, unfortunately, the physician is likely to be absent or asleep. The period of remission in such a case is always imperfect, and of short duration.

The physician returns to his patient to find him in the midst of another paroxysm; and this differs from the last mainly in the fact, that it is of still greater violence. The various local lesions with which the disease has become complicated are all the more formidable from the manifest exhaustion of the vital powers of the system.

We must now expect, that death will speedily follow, or that there will be a long and tedious continuance of the fever, under the retroäctive influence of the local lesions which have been produced, with occasional periods of partial relief, but with repeated relapses and backsets, ending perhaps in final recovery, but with more or less of chronic congestion and hypertrophy of the viscera, which are troublesome through life. A great variety of names have been applied to the disease taking this prolongated course; but when death ensues, on or about the fifth day, it has been commonly called malignant fever; which name Sydenham considered, in his time, to be more destructive to human life than gunpowder. This constantly varying nomenclature is well calculated to lead physicians fatally astray in the treatment; and it can only be useful as an apology to the public for the loss of patients. My belief is, that the character of the disease has undergone little change since the time of Hippocrates. Names alone have changed. So far as I am capable of judging of these things from

my own observations, it certainly is true that no material change has occurred in the character of this grave form of fever, since I first became familiar with the disease, as it prevails in the South, in the summer and autumn of 1819. I had much to do with it at that time, and have seen many cases every year since, without being able to discover any important changes, except as the disease varies in intensity in different years and cases; nor am I convinced that the indications of cure are different. Like plague, small-pox, measles, etc., this form of fever is a specific disease, governed in its etiology and pathology by fixed and immutable laws. Such it probably ever has been, and such it probably ever will be, whatever may be the names by which it may be called.

LECTURE VII.

REMITTENT FEVER.

AUTHORS agree in the opinion that remittent fever is materially influenced in its character and severity by the season of the year, as well as by the locality in which it prevails; but it is acknowledged to be most common and violent in autumn. For this reason it is not unfrequently denominated autumnal fever, or autumnal bilious fever. It is generally conceded, also, that this form of fever sometimes prevails somewhat extensively both in spring and summer. But writers are apt to take little notice of the fact, that remittent fever prevails also in winter, and sometimes extensively. These cases, however, in general, as I have before remarked, are attributed to the influence of causes originating and acting upon the system in autumn, and are, therefore, still spoken of as autumnal fevers. I am of the opinion, however, as you are all aware, that the cause of periodic fever, whatever may be its source and character, originates and acts upon the system at all seasons; although it is doubtless true, that it prevails in greatest intensity in summer