that were allowed to run into the low continued form; and even here, the contagion was circumscribed within very narrow limits. The types were, the simple tertian, the double tertian, the quotidian, the quartan, and the irregular. The following will give some idea of the relative numbers of these forms.-A native detachment at Dindigul, 255 strong, suffered in the following proportion: simp. tert. 30; doub. tert. 26; irreg. 24; quotid. 13; quart. 4. The quotidian form was well marked, returning at nearly equal periods, often attacking weak constitutions, and leaving but little time for taking the bark. It was more apt to occasion visceral obstructions and oedematus swellings than any other form of the disease. The quartan was rare, but obstinate, and frequently productive of splenic obstruction and dropsy. The irregular was very troublesome, and seemed to correspond with Hoffman's semi-tertian.

The Tamool, or native practitioners, ascribe the epidemic fever chiefly to two causes-a superabundance of moisture in the air and earth, and the bad quality of the water owing to unwholesome solutions. We think there is much truth in their opinions, and have had reason to believe ourselves, that the water, as well as the air, becomes impregnated with morbific miasmata.

Treatment. On the first appearance of the epidemic, no time was lost in clearing out the bowels by brisk purgatives; and soon after the medicine had ceased to operate, the cinchona was prescribed, observing this rule respecting it, that, the nearer the time of giving the last dose of bark for the day is brought to the period of attack of the cold stage, the more likely will it be to accomplish the purpose intended. From six to eight drachms of the fresh powdered bark, taken in substance, were commonly sufficient to keep off a fit, especially if given in the four or five hours preceding the paroxysm. Some of the native stomachs could not bear the powder, unless mixed with ginger, or given in infusion or decoction, with tinct. cinchona, and conf. aromat. As the bark sometimes constipated, a few grains of rhubarb were added, or laxative glysters used. Thirty or forty drops of laudanum, with half an ounce of the acetate of ammonia, given at the commencement of the hot fit, often had the effect of shortening it, sustaining the strength, and rendering the stomach retentive. When the perspiration begins to flow, the drink ought to be tepid; but when the body is hot and the skin dry, cold water is both grateful and salutary. The bark must be continued for some time after the fever disappears, to prevent recurrence. The committee, as was to be expected from the schools of debility and putrescency in which they were educated, declaimed against purgatives in this fever, "lest they be productive of mischief, by occasioning irritation, debility, and ultimately an obstinate disease-mindful of the lesson that was taught them in early life, by the writings of the judicious Hoffman," &c. I quote this passage, not to say that I think drastic purgatives necessary in the simple form of intermittent, for I know that they are unnecessary, and sometimes hurtful; but to show that the committee were disciples of Hoffman and of Spasm.

When the fever, as too often happened, ran its course some days unchecked by medicine, then the case was altered, for abdominal

congestion and visceral obstruction soon took place, and a dangerous state of the disease was induced. In these distressing circumstances, change of climate was necessary, and a course of calomel. When the mouth became affected, some of the most unpleasant symptoms disappeared, and then the bark was administered with more safety.

The committee not unfrequently, met with obstinate intermittents, unaccompanied apparently by visceral obstruction, in which bark was unavailing. They sometimes tried with success sulphuric æther in doses of one drachm and a half, taken at the approach of the cold fit; and also full doses of laudanum. The sulphate of zinc did not answer. The Hindoo practitioners have used arsenic in intermittent fevers time immemorial, and entertain a high opinion of its virtues; but the committee do not approve of it much, though it sometimes succeeded when all other remedies had failed. The cold affusion was useful in the hot fits; nay, daily immersion in the sea sometimes proved the happy means of checking agues which had baffled every other exertion. A blister to the nape of the neck will sometimes check the recurrence of the cold fit. A full dose of the tinct. rhei et aloes, at bed-time, was found by Mr. Tait, of Trichinopoly, to stop agues that resisted every other remedy. Notwithstanding all our endeavours, the disease will sometimes run on to coma and death.

"In such cases calomel or the blue pill, continued till the mouth is a little affected, even when no obstruction has taken place, is often found to be of the greatest service." 145.

On this I shall make no comment; the fact speaks for itself. Alarming bowel complaints sometimes supervene on long protracted intermittents; not attended with much straining, but of an obstinate and debilitating nature, requiring opiates, weak cretaceous mixtures, and aromatics. They too often prove fatal, especially among the natives.

Edematous swellings and ascites not unfrequently supervene from pure debility. These, where no visceral obstruction prevailed, were best treated by tincture of squills, ginger, and tinct. cinchonæ, together with frequent friction with dry flannel, and proper attention to the ingesta. But when the bowels were firm, and there was any suspicion of organic derangement in the abdomen, calomel in small doses was conjoined with the squills; or what answered better, the pilula hydrargyri. ·

This fever coming on patients who had previously suffered from liver affections or dysentery, assumed an alarming and complex form, requiring the nicest management. Bark was here to be used with great caution. Even the infusion and decoction were dangerous, where there was any pain or uneasiness in the right side. A blister, without loss of time, was then applied, and mercury had recourse to.-R. Pil. hydrargyri gr. vj; pulv. ipecac. gr. iij. opii. gr. fs; fiant pilulæ tres. Sumatur una ter die; resuming the use of the cinchona as the hepatic symptoms subside. Sometimes the two remedies were combined, where the hepatic affection was chronic and not very obtrusive. An issue in the right side, with bitters and tonics, often proved serviceable. Change of air was superior to all

other means, and diet of course required constant attention. Gentle exercise; flannel next the skin, especially where hepatic affections existed; and the most scrupulous attention to the state of the bowels.

When, from the appearance of the symptoms, a fever of the remittent kind is approaching, emetics are improper; in this case, the committee recommended six grains of calomel and six of James's powder to be taken in the course of 12 hours, which will generally produce copious evacuations, and sometimes diaphoresis.

"On the second day, when the paroxysm will, in many cases, be found every way more severe than on the first, no time is to be lost in having recourse to mercury, the remedy which, at such times, can best be relied on for producing a proper intermission. Seven or eight grains of calomel, with three grains of camphor, are to be well rubbed together, and made into four pills, one of which is to be taken every three hours during the day. These will often have the desired effect, if continued for two or three days, by producing a desirable change in the habit, and so favourable a remission, that the bark may be given with safety." 154.

If this be not a decisive evidence in favour of the anti-febrile powers of mercury on the constitution, I know not what evidence would carry conviction to the minds of the declaimers against that medicine. It is the more satisfactory, as it comes from the anti-mercurial party themselves, surrounded with the prejudices of debility and putrescency

The principal native remedies employed by the Tamool practitioners were, white arsenic, about the 15th part of a grain, twice a day; the barks of the Swietenia febrifuga and melia Azadirachta ; the Catcaranja nut; the Chukkoo, (Amom. Zingib.); the Sison Ammi; bark of the Acacia Arabica, and Tellicherry bark.

We have lately heard it urged, that the causes of intermittent and remittent fevers must necessarily be sought in low and marshy situations; whereas the testimony of unquestionable writers, and this document particularly, proves, that febrific miasmata may rise, under certain conditions, from almost any soil; and what is still more extraordinary, that these febrific miasmata may be carried, by currents of air, to a distance far exceeding what has been laid down by some most respectable writers on the subject. This epidemic of India spread its poisonous breath from South to North, in the direction of the monsoon, and was confidently believed by the natives to have its sources in the Pylney mountains, whose overgrown woods, unventilated vallies, and stagnant marshes, could not fail to engender a more rapidly dangerous condition of the atmosphere, than that brought about by the same general causes on the drier and less woody plains of the eastern ranges of the Peninsula.

The observations of the committee are corroborated by the testimony of others, particularly Zimmerman and Jackson.

"Fevers of this sort, (says the latter,) arise in particular countries, or districts of a country. They travel in certain tracts : sometimes confined to narrow bounds; at other times they are more wide

ly diffused."-Medical Dep. Brit. Army, p. 212. See also Zimmerman's "Experience," vol. ii. p. 155.

It is greatly to be lamented, that some of the energetic modes of treatment lately introduced into the methodus medendi of fever had not been tried in the remittent forms of the eastern epidemic. It does not appear that a lancet was wet in any part of the epidemic range from Cape Comorin to the Cavery; and therefore it is in vain for our Oriental brethren to say that it would not have been useful, when they never gave it a trial. The evidence, however, in favour of MERCURY is most unequivocal, and will probably silence, if any thing can, the clamour which has been raised against it in this country.

Observations on the Fever prevalent in the province of Guzzerat, with general remarks on the action of Mercury in the diseases of India. By A. GIBSON, Bombay Medical Department.

SEC. IV. It is now pretty generally known, that, in the fevers of India, mercury alone is to be relied on in the early treatment, to obviate immediate danger.-It may be supposed to have three modes of action 1st, On the hepatic system; 2dly, On the intestinal canal ; 3dly, On the general constitution.--Probably all these modes of action are essential to a perfect cure; and if either is deficient, the certain consequence is death, or chronic obstructions, which only yield, if ever, to a change of climate.

1st, If the liver is not acted on, it must, from the determination of blood to it, during the increased febrile action, be in great danger of being disorganized, or of its penicilli becoming consolidated, as a termination of the inflammatory state.

2dly, If the bowels are torpid and constipated, the liver will still be in the same danger; for though it may be pervious and active enough to eliminate bile from the blood sent to it in the healthy state, and in the moderate action of the system, yet during the continued accessions of fever, it may be overpowered by the increased sanguineous afflux, which must either augment, or continue stationary, as long as the alimentary canal refuses to be moved by such means as would reduce or abate the volume of circulating fluid.

3dly, I have commonly observed the cure to be incomplete, unless the general constitution was affected; for such is the type which the fever very frequently assumes, that, unless counteraction is excited in the system, by the specific power of mercury, the healthy state both of the liver and bowels is inadequate to a cure; the paroxysms become continued; the febrile state is established, and in progress of time irremediable debility follows.

The species of fever, which I have seen prevailing in the province of Guzzerat, partakes chiefly of the typhoid character, though commonly denominated, I presume incorrectly, bilious. It differs from the latter form of fever in requiring less evacuation; and from the former, in the remission being such as to admit of stimuli being administered. The effects of stimuli are what one would look for in

an inflammatory diathesis; yet excessive evacuations of any kind seem only to hasten the fatal termination.

The affinity between the constitutional symptoms, at the period either preceding the attack of fever, when the patient has been long languishing and unwell, or consequent to it, when the mercury has acted imperfectly, and hectic fever commenced, cannot but strike every observant practitioner. Irregular accessions of slight rigors, sometimes quotidian, and sometimes not recurring for days, at uncertain intervals; burning heat of the palms and feet, extending up the legs; the feelings and actual heat of the body, always above natural ; a quick pulse readily increased by the most gentle exercises; the easy excitement of the system to high febrile irritation, by the smallest meal of animal food and use of wine; the flushed countenance: cold clammy sweatings at one period, and dry, hot, parched skin at another, with emaciations, seems to correspond with the phenomena of hectic. But as the phenomena in question occur without suppuration, we must seek for a cause in the general debilitated state of the system, unless an idiopathic origin is allowed; and although I am not prepared to defend an opinion on this important point, the further investigation of the subject by others, may substantiate the hint at some furture period. A change to a cold climate, if timely adopted, or even to another with fewer natural disadvantages, and if by sea, so much the better, fortunately, in most instances, serves towards a recovery. In the pining state above described, are the majority of those composing the Convalescent-list of an European regiment at sickly stations. Among the officers also who embark for England on sick-leave, will be found a very large proportion in a similar state. But the soldier, from his humble situation, has not this resource at command, but must patiently wait till a relief of his regiment takes place, when the only chance of a recovery is in his power; but in this hope how many perish! medicine being now exhausted on him in vain.

Absolute confinement during this unhealthy state of the body, is not often long endured, the person going about his usual occupation, unwilling to lay himself up in a country where the depressing passions are so predominant, and disease so fatal. But with a multiplicity of uneasy feelings, and a gradual decay of constitution, yet ignorant where to assign his chief complaint, in sleepless nights and restless days, he lingers on a life of extreme misery, till debility, or fever, or its relapse, compel him to his sick-chamber.

In better climates, the phlogistic state of the system is adverse to the introduction of mercury; but the prudent abstraction of blood happily reduces it to that standard which is most favourable for its action. In India, however, in fever, the disease in which this is most speedily to be desired, the same mean would but in very few cases be admissible; for the debility is so great and instantaneous, as well as the tendency to putridity, that only in the robust newcomer is it, if ever, to be hazarded.*

The spontaneous hæmorrhages which are so distressing in the worst cases, from the nose, mouth, and ears, have always appeared to me to hasten death. Indeed I do not remember an instance of hæmorrhage which did not prove fatal, and without exhibiting the smallest remission, not even before the period when