ed, and, indeed, can scarcely be detected, except by auscultation, before the patient is found to be in collapse, or the sinking stage. Few diseases are more fatal to the negro, in whom the vital powers are less energetic than in the white subject; and the sinking stage of malignant disease proportionally more rapid. On account of this tendency to early prostration of strength, this form of the disease is generally called typhoid; but it is not to be doubted that the debilitated condition into which patients sometimes fall, even at so early a period, is not direct, but indirect ; being preceded by a stage of constitutional excitement above the standard of health. There is a stage in such cases, therefore, in which the contra-stimulant treatment is indicated, and required to be promptly and vigorously applied; but it is of the utmost importance that it should be well timed. After the stage of collapse is initiated, the patient cannot bear depletion. Bloodletting, both general and topical, tartar emetic, nitrate of potash, and calomel, are all important remedies; but quinia in this, as in other forms of the disease, is the most valuable of all our remedies. It should be given from the early inception of the disease, as much as possible in the remissions; and in sedative doses; guarding against prostration by the use of carbonate of ammonia, sinapisms, and the internal administration of chloroform. The nervous character of the disease, in its early stages, and the thoracic congestions accompanying the

chills or cold stages, call especially for the internal use of chloroform, which may be given several times a day in pretty full doses.

But on account of the insidious character of this disease in the negro, there is sometimes a difficulty in bringing the cases under proper treatment in the first stages of the fever, when alone is it easily controlled. A negro, while at his usual labor, complains of debility and loss of energy, and particularly of weakness in his limbs, which continue for an hour or two, and then pass away. The next day there is a recurrence of the same symptoms, only a little more severe; and for several successive days the indisposition is repeated without attracting much attention; until finally he is quite prostrate, and soon afterward in the sinking stage of the disease, or stage of collapse. It can hardly be expected that in the beginning of such an epidemic prompt and efficient treatment will be applied; but after a few fatal cases have occurred, there can be little excuse for delays in the treatment which deprive the patients of almost their only chance of recovery. No diseases, not even cholera and yellow fever, require earlier and more prompt attention than pneumonic fever.

It may be proper, in this connection, to say something of the remedial power of veratrum viride, especially as it is in pneumonia, or the pneumonic form of fever, that it is more particularly recommended. The effect of this remedy in restraining the frequency

of the pulse is well established, and the evils arising from undue arterial excitement are so great, that high expectations in regard to the remedial efficacy of this article, in all such cases, have been raised in the minds of medical men. But it is true in this, as in many other cases, that expectations founded upon theoretical views have not been fully realized. The medicine is a harsh one, and frequently the irritation it produces in the stomach and bowels is seriously objectionable. No doubt it is a valuable remedy in skilful hands, but it must be used with extreme care and caution, or injury will result from it. I have generally preferred the aconite to answer the same indications; for, although it may be somewhat less prompt in its influence over arterial action, it certainly exercises a more kindly effect upon the nervous system, and with less painful effects upon the mucous tissue. Indeed, we have few remedies which exert so much control over disordered innervation, and over cerebral, spinal, and meningeal irritation. Its efficacy as an external application, in neuralgic affections, is also well established. But this is also a virulent poison, when given in too large quantity, and you cannot well be too cautious in its exhibition. I have generally used it in conjunction with tartar emetic, and the nitrate of potassa; and am inclined to the opinion that every dose of tartar emetic given in this disease should be accompanied with a dose of aconite, as its proper adjuvant remedy.

THIS, like other, and more than most other, forms of fever, comes on in a slow and insidious manner, with exacerbations and intermissions; and, unless relieved by treatment, increasing in intensity from day to day; but in general several days elapse before the sufferer is induced by the urgency of the symptoms to call for medical aid, or even suspects that he is threatened with serious disease. The early paroxysms are very obscure, and frequently they are evidenced only by sensations of debility in the limbs, and especially in the knees. These paroxysms are of short continuance, and the periods of apyrexia afford little signs or sensations of disorder. Nor is it possible in this, any more than in the other forms of fever, to determine from the symptoms alone what is to become its peculiar character; or in what organs of the body its principal local lesion will be located. Indeed, the head, the chest, and the stomach, are more likely to exhibit the first signs of local lesion, and a week or more passes away before the real tendency of the fever in this respect can be fully determined.

Under the mysterious power of some epidemic influence, or the operation of some other unknown cause, the symptoms after a while begin to indicate that the seat of the principal local affection is to be in the bowels. This appears to consist in congestion, and afterward inflammation of the mucous membrane of the intestinal canal, beginning in the lower portion of the ileum, and probably at the ileo-cocal valve. There is generally little evidence, at least in the early stages, that the muscular structures are at all involved, the symptoms not being those of enteritis. The soreness and pain are less, and the pulse is fuller and less frequent. These enteric symptoms are scarcely initiated before the signs of prostration appear, which usually attend upon inflammation of the mucous tissues; and the local lesion becomes a source of nervous irritation, as in symptomatic fever. The apyrexiæ, from this cause, become less distinct, and the case is apt to be declared one of continued fever.

Whatever may be the case in other parts of the world, it can scarcely be doubted by any one accustomed to treat the fevers prevailing in the South, that the disease which I am now considering is a form of periodic fever. It begins as in other forms which are distinguished from each other, mainly, by their peculiar local lesions; and like them it continues without any marked distinctive symptoms, until the febrile impression is made upon the mucous membrane of