times immediately fatal. But again; do not suffer the life of your patient to be sacrificed in this apoplectic form of fever for the want of the lancet, because forsooth it is symptomatic of the invasion of an intermittent, in which blood-letting in general is not advisable or necessary. Venesection, in the cold stage of an intermittent, has been lately recommended in the Edinburgh Journal, as if a new practice. It has been long since well understood in the United States. Be cautious, too, not to commit yourselves by denominating this form of fever apoplexy, for your patient in a few hours may be relieved, and the want of discrimination in you be censured for not foreseeing this result.

"Purges, in like manner, are generally improper in the first or cold stage of fever. So also, are such drinks as cream of tartar and tamarinds, &c., but they are not improper in the present state of stupor or phrenitis; they are now indicated. And recollect, too, that cathartics are not only indicated for the purpose of diminishing the fluids of the system, but also to transfer excitement from the brain, and thereby also to lessen the quantity of fluids there determined by such irritation. With this view, saline cathartics, or stimulant cathartics, composed of jalap and calomel, are to be preferred. I cannot, however, too severely reprobate the use of the small doses of calomel, usually and promiscuously prescribed under the appellation of fever powders; they are indeed fever powders, for they most effectually continue fever. Calomel, as a cathartic, in the beginning of fevers, is among the best that can be employed, and occasionally too, may be administered in the progress of the fever. It excites a degree of nausea, sometimes vomiting; unloads the biliary organs, dislodges scybala, invites a large secretion into the intestines; and afterwards, in unison with antimony, has a sensible effect upon the surface, as well as the excretory organs in general. Such purgatives as excite the whole system, as does colocynth, gamboge, &c., are to be avoided. This is where cathartics are indicated to empty the intestines, and thereby to prevent the absorption of the contents of the belly, which, as a means of repletion, would aggravate the disease, while by their qality they would add to the malignancy of such fever. Castor oil is frequently prescribed as a domestic purge in the beginning of fevers; as a means of emptying the intestinal tube it is effectual, but not so in its operation upon the liver, or the excretions of the general system. Enemata are also indicated, as more immediate in their operation than cathartic medicines.

"In the treatment of fever it frequently becomes necessary to combine all your forces, and as nearly as possible at the same time, and not in the successive and inefficient manner that we see remedies often directed. Such procedure is similar to that of a commander who suffers his army to be cut off, regiment by regiment; whereas, by one general engagement he might have Leen sure of victory, and that with a small loss of his men. Thus in fevers the powers of life are gradually destroyed by the continuance of the disease, and the many repeated, feeble and insufficient attempts in succession to bring about a cure-whereas, by summoning all your resources at the same time, you put the enemy to flight, and prevent that loss of strength that otherwise would be the result. We should not wait in such cases for the slow operation of cathartics, and which are rendered still more slow by the influence of the fever upon the system, but immediately administer the domestic injection, by which you will remove a great additional source of irritation from the bowels. Take oil, molasses, or honey; common salt, aa ss.; water b.i. M.; or equal parts of milk and water; or soft soap, ü., water bj.; or which is still more active, castor oil, 3s., glauber salts, 3s., aq. pluvial. bi. M.

"Blisters are another means of diverting the excitement from the brain to the surface of the body, not by the mere discharge of fluids they occasion, but by the excitement they produce upon the surface, or to the part to which they are applied. Such, too, is the opinion of Dr. Jackson, that they produce their good effects by the local affection they create.* Armstrong, too, highly approves of blisters, as among the means of breaking up febrile action. But even the derivation of the fluids in these cases is useful, by abstracting them from the brain to which they tend, and the sooner blisters are applied the better. They should be applied behind the ears, between the shoulders, to the wrists, to the ankles, or to the præcordia; that is, to the most sensible parts of the body, for the very purpose of creating new and powerful excitement.

Sudorifics also constitute an important class of remedies in this stage and state of fever-that is, such sudorifics as at the same time that they relax the surface of the body, also diminish excitement in general. The sp. mindereri-aq. acetat amm., may be advantageously combined with a portion of tart. antimony. Antimony, in some of its forms, especially tartarized antimony, the tartrite of antimony and potass. gr.

* Jackson on Fevers, 224.

ij. in eight doses, with cream of tartar, 3ij., or in sweetened water alone. Vin. antimoniale, xxx. gtt. to 3i., the pulvis antimonialis, that is, the antim. calc. phosph. gr. iv. to gr. vi. every two hours, in syrup. The real James' powder, from gr. x. to gr. xv. or Di. every two or three hours, or combined with calomel, from gr. iij. to gr. vi. of each combined, repeated every three hours. These diaphoretic or sudorific medicines should also be aided in their operation by suitable drinks. When the patient is in the use of antimonial medicines, his drink should be some of the following:-toast water, catmint tea, (nepeta cataria,) balm tea, (melissa officinalis,) common tea, (thea viridis,) bran tea, rice or barley water. But when the patient is not in the use of antimonial medicines, he may make use of other drinks, which he will find both more grateful and useful during the heat and thirst of fever, as lemonade, apple water, tamarind water, currant jelly and water, molasses and water with the addition of a small quantity of vinegar; this is commonly called switchell by our eastern brethren, and a most excellent drink it is too in fevers, unless the bowels may be too freely opened. It is frequently directed by me in the hospital. Vinegar whey, too, is another valuable drink in this excited state of the system; but these acid drinks, taken during the use of antimonial medicines, are frequently attended with pain in the bowels and in some instances they render those medicines dangerously active. They should give place, therefore, to some of those before enumerated."

Presuming that the western student of medicine, and the western practitioner of good intellect and some year's experience, have carefully read and studied the foregoing "Lecture," we ask the former what he has learnt from it, of a decided, pointed, and definite character? and the latter, what he has met with in it, in accordance with the practice he has found it necessary himself to pursue? And we feel no apprehension, that the reply from either will materially conflict with the sentiments respecting the production, which we have ourselves so openly expressed in the preceding pages. On the contrary we are persuaded it will harmonize with them. We venture to say, that any intelligent, educated, and observing physician, twenty-five years of age, and of

three years standing as a practitioner, in the Mississippi Valley, could instruct Professor Hosack, were he now living, how to treat our prevailing fevers, of every description, better-vastly better, than he instructed his class respecting them, by delivering his "Lectures" to them; or than his Reverend Editor will instruct the American faculty, by the publication of those "Lectures." Yet has Professor Chapman announced to the world that he "considers the practical part (of the "Lectures") sound; and that it corresponds very much with his own views." We do not pronounce the practice thus concurrently recommended by Professors Hosack and Chapman unsound, as relates to the complaints of the Eastern States. Far otherwise. On that point it would be unbecoming in us to deliver our opinion. But, as respects the complaints of the Western States, we do so pronounce it, because we know it to be, unsound. To teach it therefore to pupils, who intend to pursue their profession in the West and South, is to mislead and injure them. Worse still; it is to put the lives of their patients in danger.

There are also contained in the Lectures before us certain pathological doctrines, which we deem not only groundless in themselves, but, as far as their influence may extend, pernicious in their consequences. Prominent in this respect are those which relate to contagion and humoralism - especially that form of humoralism, of which a supposed putrescent condition of the human fluids during life, constitutes an element. These doctrines, connected with a few other points of interest, will probably be made the basis, at a future period, of another critique on the work we are considering. Meantime we say distinctly now, that we regard the unfounded notions respecting contagion and putresency, contended for by the late Professor Hosack and a few other physicians, to be, in their practical effects, among the most

mischievous that have been broached by medical writers. And we further say, that there is no physician, whether he be a Professor or not,whose sphere of practice has been exclusively east of the Alleghany mountains, who is competent either to deliver lectures, or to write a book, containing correct instructions how to treat the complaints of the West. Lectures and books, containing such instructions, can be prepared only by physicians who have a practical acquaintance with such complaints. If there be positive maxims in medical science, this is one of them. And it has been long a matter of regret and surprise to us, that due action has not been taken on it by western physicians.

ART. V.-On Scarlatina, in a Letter addressed to his Son.By WILLIAM INGALLS, M.D., &c. &c. Second edition.

DR. INGALLS details three cases of Scarlatina, in his letter, with the mode of treatment which, during a long experience, he has found most successful. Remarking on the various remedies employed, we were surprised to find Dr. I. declaring that, in the treatment of Scarlatina, he was opposed to the detraction of blood by the lancet or leeches. We have been inclined to regard bleeding as one of the most potent means of subduing this formidable complaint-as indispensable in the highly inflammatory grades of the disease. Dr. I. remarks: "In the whole course of my practice in Scarlatina, I have never employed blood-letting, either general or local; and I do not recollect a single instance, in which I have had reason to regret the omission." He adds "It may be proper to state, my practice has been chiefly within the city of Boston. As