we must not forget that remittent bilious fevers sometimes assume the adynamical character of the yellow fever. In Spain as well as in the United States, the epidemic has always followed the sea coast, and the course of the great rivers. It has been called in question whether it ever really prevailed at Cordova; but it appears certain that it exercised its ravages at Carlota, five leagues to the South of Cordova, a very healthy town situated on a high hill, and open to the most salubrious winds. *

The system of Brown did not excite greater enthusiasm at Edinburgh, Milan, and Vienna, than it has excited in Mexico. Those persons of intelligence who were enabled to observe with impartiality the good and the evil produced by the stimulant system, are in general of opinion that upon the whole American medicine has gained by this revolution. The abuse of bleeding, purgatives, and all the debilitating remedies was very great indeed in the Spanish and French Colonies; and this abuse not only increased the mortality among people in bad health, but was detrimental to newly arrived Europeans, who were bled

* Berthe, p. 16. Carlota is twenty-six leagues in a straight line from the sea.

while in the enjoyment of the best health, and to whom this prophylactical treatment became a predisposing cause of disease *. Is it to be wondered at, that notwithstanding its imperfections and its deceitful simplicity, the method of Brown was productive of good in a country where an adynamical fever was treated as an inflammatory fever; where they dreaded to administer quinquina, opium, and ether; where in the greatest prostration of strength, they were patiently waiting for a crisis, prescribing all the time nitre, water of marshmallows, and infusions of scoparia dulcis? The reading of the works which have appeared on the Brownonian system induced the Spanish physicians to reason on the causes and forms of diseases. Ideas long ago announced by Sydenham, the school of Leyden, by Stoll and by Frank, have found admission into America; and they now attribute to the system of Brown a reform due to the commencement of a spirit of observation, and the general progress of intelligence.

Although the vomito is announced by a sthenical diathesis, the bleedings so warmly recommended by Rush, and frequently employed by the Mexican physicians in the great

*Pinel, T. i. p. 207. Gilbert, Maladies de Saint Domingue, p. 91.

*

epidemic of 1762 are looked upon as dangerous at Vera Cruz. Under the tropics the passage from the synoque to the typhus, and from an inflammatory state to a state of languor is so rapid, that the loss of blood, which is falsely said to be in dissolution, accelerates the general prostration of the strength. In the first period of the vomito, minoratives, baths, ice water, the use of sherbets, and other debilitating remedies are preferred. When to use the language of the school of Edinburgh the indirect debility is felt, they employ the most energetic excitants, beginning with strong doses, and gradually diminishing the power of the stimulants. Mr. Comoto was very successful in giving more than a hundred drops of sulphuric ether, and from sixty to seventy drops of tincture of opium per hour. This mode of treatment is a singular contrast to that which. is used by the lower people, and which con sists in not raising the vital strength by stimulants, but merely in employing lukewarm and mucilaginous drinks, infusions of tamarind, and fomentations on the epigastric region to calm the irritation of the abdominal system.

The experiments which were carried on at Vera Cruz till 1804, as to the use of quinquina in the yellow fever, were not at

or

tended with success *, although this bark has frequently produced the most salutary effect in the West India Islands, and in Spain †. It is possible that this difference of action arises from the variety of forms assumed by the disease, according as the remission is more or less marked, or as the gastric symptoms predominate over the adynamical symptoms. Mercurial preparations, especially calomel muriate of sweet mercury with jalap, have frequently been employed at Vera Cruz; but these remedies so much boasted at Philadelphia and Jamaica, and prescribed in ataxical fevers by the Spanish physicians of the sixteenth century, ‡ have been very generally abandoned by the Mexican physicians. They have been more fortunate in the use of frictions of oil of olives, the utility of which was acknowledged by M. Ximenez of the Havanah, by Don Juan de Arias of Carthagena,

* According to the observation of M. M. Rush and Woodhouse, they were not more successful at Philadelphia, in the epidemic of 1797. Luzuriaga, T. ii. p. 218.

Pugnet p. 367. Arejula, p. 151 and 209. Messrs. Chisholm and Seamen preferred the Cortex Angusturæ (the bark of the Bonplandia trifoliata) to the use of quinquina.

Luis Lobera de Avila, Vergel de Sanidad 1530. Andres de Laguna, sobre la cura de la pestilencia, 1566. Francisco Franco de las enfermedades contagiosas, 1569.

de las Indias *, and especially by my friend M. Keutsch, a distinguished physician of the island of Santa Cruz, who has collected many interesting observations respecting the yellow fever of the West India Islands. For some time sherbets, the juice of ananas (xugo de piña) and the influence of the palo mulato, a vegetable of the amyris genus, were considered at Vera Cruz as specifics against the vomito; but a long and melancholy experience has gradually discredited these medicines even among the lower order of Mexicans. If they are to be reckoned among the best prophylactic means, they cannot however be the basis of a curative treatment.

As an excessive heat increases the action of the bilious system, the use of ice must be very salutary under the torrid zone. Relays have been established for the purpose of carrying the snow with the greatest celerity on mules, from the slope of the volcanos of Orizaba to the port of Vera Cruz. The length of road which the snow post (posta de nieve) travels is twenty eight leagues. The Indians make choice of pieces of snow mixed with agglutinated hail. According to an antient custom they wrap up these masses with dried herbs, and sometimes even with ashes, two substances which we know to be bad conductors of caloric. Although the

* Luzuriaga, T. ii. p. 218.