IojU. (2.  S,J
ESSAY
ON
^    FEVERS:    ;
WITH THEIR
PATHOLOGICAL RELATION
TO
OZOISTE.
           BY

E. S.  GAILLARD, M. D
?>
--- 'Tis a cause that hatli no mean dependence
Upon our joint and several dignities.
TROILUS AN
X9UT
     CHARLESTON:
WALKER & EVANS, STATIONERS AND PRINTERS.
        No. 101 East Bay.
1856. 
/ 
                        TO







       S.  HENRY  DICKSON,  M.D.  LL.V.,






PROFESSOR  OF THE INSTITUTES AND PRACTICE OF  MEDICINE





                       IN THE






        Jtteiiical College of tlje cStutc of ^outlj-darolina,






               AS A MARK OF ESTEEM






 FOR HIS  PROFESSIONAL  AND PERSONAL  CHARACTER,





                        A X D





          AS  A  SINCERE  ACKNOWLEDGMENT





                      OF THE





 CONCISE YET COMPREHENSIVE COURSE OF INSTRUCTION





           RECEIVED  FROM  HIS  CHAIR,







                 THIS   ESSAY







        IS  RESPECTFULLY  DEDICATED,












             THE AUTHOR. 
 
PREFACE.
   Tins Essay was originally prepared  and presented, by the Author, as
an  Inaugural Dissertation, at the period of his graduation.
   !>y those to whom were intrusted the Scales of Justice, it was awarded
the Annual Premium  of  the  Medical  College of the State of South-
Carolina.
   This is  mentioned with much reluctance and delicacy, yet it is con-
ceived necessary; for on this  account, with the repeated requests o4'  his
<>M class-mates and friends, is  it, that the  Essay, in its original form, is
committed to the press.
   That part of the subject relating to  the Fevers mentioned  is old  and
familiar; every step of the road hears the.  impress of the multitude who
have carefully threaded its intricacies.
   The magnitude  and  boundless extent of the views and  theories  in
regard to these Fevers rendered detail and  consecutive discussion, in the
comparatively limited space allotted, impossible.  The Author has, there-
fore, by briefly considering the older and more modern views of the best
available authorities, attempted both a condensed  and  comprehensive
style.  Than this,  nothing can he more  unwelcome to the reader,  or
unsatisfactory to  the writer; yet necessity not unfrequently renders its
adoption imperative.
  The subject of Ozone is comparatively a recent one with  the profes-
sion ;  and  it is on account of this novelty, rather than  because of any
intrinsic  merit  in its discussion, that the Author feels well  assured his
production  met with so gratifying and favorable a reception.
      TTOHfiVrnirn'r, MitJdl* Fftfrfrfrrr^rrT 1st, 1856. 
 
INTERMITTENT  AND  BILIOUS  REMITTENT  FEVERS,

                   WITH  THEIR RELATION  TO

                        OZONE.
   Abnormality is not disease, as we may have the first with-
out the last, though the presence of the last presupposes the exist-
ence of ihe first.   Disease, being a perversion of a natural pro-
cess, is  necessarily progressive;  for as the presence and mani-
festation of disease argue a previous abnormality; and as we
may have abnormality without disease, it follows  as a neces-
sary consequence, that for the production of the last we must
have a progression of the first.   We see, thus, that the  genera-
tion of disease is proximately the result of a progressed abnor-
mality ; or that disease is a constantly, though  not a uniformly,
progressive abnormality; progressive  as the effect of a cause
whose only claim to be  thus considered, consists  solely in its
element of progression ;  which element  not existing, we should
have abnormality simply, and not disease.  More briefly :  Dis-
ease implies  the progressive action of its cause ; and the rela-
tion between disease and abnormality is alone dependent upon
the extent  of this action.  Seeing, then, that  disease  is, in its
definition, but a progressed abnormality, and knowing how illi-
mitable are the causes  which produce this state, it  remains for
us but to recollect that the continued action of any single cause
is sufficient to originate in the system its correlative effect, and
thus to explain the innumerable phases in which disease is pre-
sented to us.
  It is our  purpose to write of that which gives a  title  to this
article, speaking of it thus  in the singular number as having
more immediate reference to a community of type,  than to that
signification which the plurality of names would imply.  The
two diseases, though separated by authors  for descriptive  and 
8
therapeutic convenience, should not. on this account, be consid-
ered as distinct specialties ;  for most of our modern authorities
would find the relative exposition of their opinions in the words
of him who defines "Intermittent the type; Remittent Fever as
a manifestation of the aggravation, or modification of the type."
  Before,  however,  stating  the  abundant  reasons  why  these
Fevers may thus together be treated,  it would be more relevant
in an introduction to the subject, first to speak of the great class
which claims  them as a sub-division.  In doing so, il will  be
only to  repeat what every student has felt and every writer
dwelt upon—the impossibility of defining the long catalogue of
symptoms which uniformly should be present, to constitute thiit
peculiar condition of the system, to which has  been given  the
generic  term,  Fever.   The failure  of "The  Gre;it  Scotch-
man " in such  an attempt,  and after him (we would  almost say
necessarily) a  host of others, proves the obscurity of  the subject
and  difficulty  of the task.   It has been a professional search
after the Philosopher's stone—a futile attempt  "ex  fumo dare
lucem."   Cullen, in  meaning, regards Fever  as a cold stage,
succeeded by a hot and then a sweating  stage.  Now, as we
may have the hot  without  the cold stag', and the sweating
without either; or  again,  any one singe,  neither preceded nor
followed by its correlative, it is clear that there can  not be the
least claim to  a definition  of that state, whose phenomena are
all to be classed under the word in question, and all on which
his  warmest admirers  may  insist  is, that he has luruished  the
most correct descrij>iion which had ever previously  boon given
of the subject—the  least proof of interruption, or anomaly  in
his  stages, transforms the definition into a description.  Fever
has never been elucidated  by the records, or researches of Mor-
bid Anatomy;  and at present we have no better definition than
that of Fordyce's, that "Fever is  a disease affecting the whole
system."  We have, of course, all the evidences in these Fevers
which characterize Idiopathic Fevers generally—remission, and
still more remarkably, intermission—in those uniform and  pecu-
liar effects which, never to an incidental, can only he attributed
to a specific cause:  the frequency of pulse, as vitally affecting
our  prognosis, (so  entirely  the  reverse  in  the  Symptomatic
Fevers,) and lastly, that sub, and sometimes defibrination of 
9
 the blood, as relative to the proportion of the red corpuscles so
 invariably  observed.   Our attention  is  next riveted  by that
 incomprehensible element, periodicity, so conspicuously stamped
 on every page of their history; not that periodicity is unobser-
 vable in  all Fevers, for we know the contrary to be the case;
 but that it is in these Fevers so  uniformly and palpably mani-
 fested, that they are themselves cited  as  the very type of the
 phenomenon.  Any periodicity,  contradictive in its manifesta-
 tions of that which is impressed upon us  by the harmonies of
 nature, implies an  unnatural, or  it may be, a diseased state of
 the  system.  Natural periodicity is exhibited  in diurnal and
 septenary periods, and when otherwise, is the effect of a cause
 which we recognize as disease.  Chossat remarks, that there is
 even in  the diurnal cycle a periodicity in respiration, and con-
 sequently in calorification; proving his position by explaining—
 a phenomenon but hitherto observed by all—the greater diffi-
 culty of bearing exposure to cold between midnight and early
 morning, than at any other period in  the twenty-four hours.
 Scharling observes, that  the  maximum  of carbonic  acid is
 exhaled before and after  noon; the minimum before and after
 midnight;  corroborating  thus, by proof the truth of Chossat's
 assertions ; while,  at  the same time he gives us  the rationale
 of the fact.  By the unprofessional this mystery has not gone
 unobserved ; and Dickens chronicles this truth, when one of his
• characters is described to us, in the quaint language of the peo-
 ple, as "going out with  the  tide;" shewing, in some  obscure
 way, the poriodic effect of lunar influences, even upon the sands
 in the glass of life.  In  the  inorganic world we observe this
 periodicity in that, obscure causation, under which the massive
 volcano emits  into  the superincumbent ether the liquid contents
 of its bosom ;  in the material, from the  exquisitely exact revo-
 lution of our globe and its sister planets ; in the progress of the
 tidal  wave, registering in  its course the effect of a cause, resi-
 dent  in  "the  liquid  orb" which  controls it.  The vegetable
 world shows it to us, in the specific, duration of time which, as
 well  in the highest as the lowest of its specimens, governs the
 several and specific stages of their existence; whilst, when we
 look  at the animal,  we mark the impress, in the manifestations
 of those habits which so strictly rule, as to similate their Creator 
10
in the development of another  nature.  Lastly, though  more
beautifully, does it speak to us, in the menstrual revolution, of that
mysterious function which, no less obscurely than surely, pre-
sides over  the very perpetuation of  our  being.  Periodicity is
one of those  obscurities of nature which we yet "see through
a  glass darkly;" totally incomprehensible  and unexplained.
It is, in a medical point of  view, the Gordian knot which, una-
ble to untie, we  yet cut with the Alexandrian sword of spe-
cific medication.  The effect of  this  is as unintelligible as the
cause which demands it; but serving to prove to us, that though
the chart of nature be constantly before us,  and studying  ever,
we seek to be guided by it, yet the  needle of Science, which
directs our course,  must not unfrequently be corrected by the
observations of tradition and experience.   It is no very flatter-
ing fact to those enthusiasts in the  profession, who look alone to
Science for revelation, that accident,  and a praiseworthy obedi-
ence to the dictates of tradition,  have contributed some of the
most valuable weapons, in our therapeutical armory.  Accident
has revealed to us the value of cinchona; and when the Chem-
ist teaches that morphine and beeberine are isomeric, or in  com-
position identical, we must, before acting on the information,
learn with  surprise our practice, from the  infallible records of
experience.  These collaterals, then, though not the legitimate
offsprings  of  Science, are  by  no  means to be despised,  and
should, to the profession, as its many branches are to nature, be
always useful and effective handmaids.   As an intimate and a
close study of periodicity is essentially requisite to ;i  satisfac-
tory and correct practice ; so the increase, climax, and decrease
of disease  must be accurately noted, to  build upon so good  a
foundation  the structure of a rational medication.  The incom-
prehensibility of disease, without the previous study of all the
phases of periodicity, has  been beautifully illustrated by the
utter  baldness  and lack of interest  which  the perusal of the
most enchaining Epic must induce  in the  mind of him  who,
neglecting  the argument and the introduction, seeks instruction
and  amusement alone in the conclusion.   Diseases, from the
operation of this law, have been  classified into the self-limiting,
the doubtful,  and the unlimited—terms so self-explanitory as to
need no relative comment.  It may be observed, that the second 
11
class has been  much diminished, though each diminution has
been the subject of the warmest controversy.  Of this there
cannot be an apter instance than the attempt to class Typhus
Fever under the  head of the self-limiting.   Taking as a rule,
that diseases of this class  cannot be abbreviated;  that each
attempt to do so originates a danger not otherwise existing; that
the mi'decine expectante treatment is chiefly required ; and the
fact that Typhus can be, and  has been  "jugulated " in each
and all  of its stages,  and we have the strongest  argument
against the reasonableness, or justice of such  a transfer.  We
must hope, however, that this second class may be yet  farther
diminished, as  thus shall patients be saved much of that harsh
medication which would otherwise be imperatively demanded.
" It  is  worthy  of remark, that  all those diseases \vhich have
been doubtfully assigned a  place among the  Eruptive  Fevers
belong to this second class."  Many diseases,  which once were
classed under the head of self-limiting, have been transferred to
the  last  class.   Among  these diseases  so transferred, we find
Intermittent Fever assigned its former position, from the incor-
rect induction which would  classify a disease, not by its cause,
but  rather  by the characteristics which mark its paroxysms.
Before the discovery of that great specific—so inestimable a
boon to mankind—it was extremely difficult to check this dis-
ease, lasting, as  it  did  then, thirty, seventy, not unfrequently
one hundred days ; and with that Procrustean spirit of accom-
modation, innate,-as it would seem, in the minds of all men, it
was proposed and argued that the disease was, in  itself, salu-
tary, and any  attempt to abbreviate it altogether  hazardous.
The absurdity of this  proposition was only acknowledged,
when the ability  to control the subject of it was exhibited ; and
happily the disease is now stricken from the roll it once  so con-
spicuously occupied.  The latent period, or that of incubation,
is extremely various and uncertain, extending, as 'tis said, from
ten to twenty days.  A favorite theory would make the duration
of this period, and the efficiency, or intensity of the impressing
cause in an  inverse ratio.  Of this  there is much uncertainty;
for in the Fever  of our  Southern States we  not unfrequently
find, that the termination of a nine-day incubation will usher
in an attack of the most virulent character. When on the African 
12
 coast, as Burnett informs us, after the most imprudent exposure,
 fatigue and subjection to all of those agents which most aggra-
 vate the symptoms and danger of this disease, there is not the
 slightest manifestation of indisposition until the eighteenth, and
 frequently the  thirtieth day.  The virulence of the attack  is
 most generally, if not universally, in a direct  ratio with the
 intensity and efficiency of the impressing cause ;  but circum-
 stances, as well as facts,  forbid our believing that this intensity.
 and the duration of the incubation, are always  relative.  The
 predisposition of the  individual, doubtless, frequently  modifies
 the  duration  of this  period.  We  have  frequent  instances,
 recorded in the books, of a six-months', or even of a year's incu-
 bation ; and though  these  cases are  well  authenticated,  the
 so-styled  facts  too  far tax our credulity, and we cannot  but
 believe that some collateral  circumstances, or contingencies
 have been  omitted, sufficient in themselves  to explain these
 monstrous anomalies.  During an incubation in these Fevers,
 as in  all recurrent  affections, the patient is in apparently perfect
 health ;  proving that  we cannot, in disease,  from the non-man-
 ifestation of effect, infer the simultaneous  non-existence of a
 cause.  All that can  be  said on  the  subject, therefore, is, that
 there is a latent period, varying in duration, from the action of
 causes, as yet imperfectly understood.
  As to type, we may state, before entering on the subject, that
 there have been the most multifarious and heterogeneous theo-
 ries urged, on which to build a relative argument.  There is no
 one uniformly selected ; and this is to be much regretted, for only
 in this way can we hope to avoid the confusion, obscurity, and
 diversity of opinion which now prevail in our Pyrexial Nosol-
 ogy.  Copeland's theory, that the constitution, habits, and even
 manners  of a  patient, may change  the type of  Fever,  has,
 though so frequently commented upon, no more of the Utopian
 about it, than those of many whose names might  be cited.  The
 causes that he urges may modify the type of  Fever; but to
 produce  a change of  this must be impossible.  In 'modifying
 the type, we  have an instance of the effect of age  in Infan-
 tile Remittent,  changed  as it is  in   its  symptoms,  from  the
ordinary  Remittent, by the imperfect digestion, and vermic-
ular obstructions  which  so characterize  the  subjects of it. 
13
Again,  we  have the  analogue of Copeland's views,  in the
effect produced on  disease by  sex.   We know that cerebral
congestion, producing coma and strabismus in the male infant,/
is  as marked  as  chorea and epilepsy, which  characterize the
spinal congestions of the female.   The most consistent ground'
on  which to found  a type in Fever,  has been stated,  as that
which bears a direct relation to causation.  Thus the zymotic
action of malaria gives us  many kinds of Fever, as mani-
fested by their respective symptoms, but all of a single type.
Ozone produces  its type—Catarrhal Fever, and  lastly the
zymosis of ochlesis and contagion,  respectively, Typhus Fe-
ver,  and the  exanthemata.   There  are some Fevers which
we cannot  thus  classify, as  Yellow  Fever, etc.  This should,
however, form no argument  against the justice of this theory,
but rather as only showing our inability farther to illustrate the
truth of it; a  difficulty which must terminate on the revelation.
or discovery of the cause, in each peculiar and particular dis-
ease.  The truth of this theory—and it is, we think, almost a
professional axiom—must prove  the  falsity of that doctrine
which advocates  the unity of Fevers.  How the simple mani-
festation of periodicity in continued Fevers, or their amenabil-
ity to the quinine treatment,  could suggest such a doctrine, is,
indeed, incomprehensible.  This  periodicity  has, to a certain
extent, been always manifested in continued Fevers, and where
this prevails in a malarious region, or supervenes upon a mala-
rious Fever, it is only reasonable to suppose that this agent will,
in  some measure, modify the disease.   Where this is the case,
the patient is, of course, improved by the quinine treatment,
because the effects of the agent in question have become apart
of the disease, and these effects are more amenable to this pecu-
liar antidote than to any other known.  Where, however, mala-
ria does not exist, it has been clearly proved that quinine is of
no value whatever  when administered in any of the stages of
continued  Fever.   Again, it  is well  known that a  few of the
cases of Pleurisy,  Pneumonia, etc.,  prevailing in  the South-
ern sections of our  country,  are  modified by  malarious influ-
ences, thus becoming periodical;  and that these yield promptly;
under  the quinine  treatment; so that reasoning in this very 
14
  logical method, we  might as rationally class them under one
!  general  head, and  in  the place of advocating the  doctrine
  of " unity  of Fevers,"  go one  step  in advance, and claim
  to have  established  a unity in disease.  There can be no cor-
  rect  type established  in Fevers  if we  are  to found this upon
  the  manifestation of symptoms; and  this truth  we  should
  think clearly illustrated by the  following passage, in a letter
  from one of the most eminent Physicians in the British Navy.
  Speaking of the  Fevers  he had  been called upon to treat, he
  observes:  "It has not  been considered  necessary  to  adhere
  strictly to the various names which have been applied to Remit-
  tent Fever in our Nosological  returns,  partly from  the  convic-
  tion that to do so would  only lead to misapprehension and con-
  fusion ;  partly because it  was, in many instances,  altogether
  impossible to reconcile the classification there adopted, with the
  symptoms recorded  in the cases  which were contained in the
  journals for the corresponding periods.   The Bilious Remittent
  of one person was found to be the Climatorial of another; the
  Endemic of a third, the Typhus  Icterodes of a fourth; the
  adjectives ardent, yellow, congestive, infiamatory, had all been
  used in describing the same disease.   The  character of these
  Fevers is, in fact,  such, that the  Synocha of one  day  may
  become a Remittent  on the next,  and probably ere long termi-
  nate  in  an  Intermittent.  The ephemeral of little force  may
  suddenly become one of  high vascular  action, or at the same
  time, but in a different subject, pass  rapidly through the stage
  of excitement and at once enter upon the Typhoid ; while that
  which invades with  great intensity of  action, may frequently
  be of ephemeral existence only.  It is  therefore obvious that it
  is not until the Fever approaches  its termination, that it can be
  brought under anyone of the previous heads; consequently, in
  a practical point  of view, such visionary distinctions are of lit-
  tle, or no importance." We want,  then, no better proof of the im-
  practicability of a classification, founded on symptoms in Fever,
  than the Nosological melange here introduced, and cannot con-
•  ceive of any system, in which a worse  mistake could be made.
  That classificatioji which leads  a truly scientific mind  to con-
  found a simple Intermittent with Typhus Icterodes should no lon-
  ger be tolerated.  We certainly could have no better theory, or 
15
basis of classification, than that which has now so many able ad-f
vocates, viz :  that every type in Fever should bear a direct rela-
tion to the cause of the disease; and each subdivision of Nosology
should be but an exemplification of this simple and rational law.'
  It is now better, before  entering minutely upon our subject,
that we should give the reasons which actuated us, in uniting
under one head, the two diseases which give the title to this arti-
cle.  In doing this, with comparative want of experience, we
are of course governed entirely by authorities.  Wilson observes:
" When  the fits of the Quotidian are  lengthened there is no
time for any  apyrexia, and the Intermittent is changed into a
Remittent."  Dunglinson:  " The prodromic symptoms of Re-
mittents are analagous to those of Intermittents; differ so little
indeed from  them, as not  to require enumeration."   Watson,
speaking of Intermittents, observes : " When the intermissions
are imperfect, the patient remaining ill and uncomfortable in a
less degree than during the  paroxysm, then the  complaint  is
said to be  a  Remittent Fever."  Again: " Bilious  Remittent
Fever is closely allied, in  its nature, the localities in which  it
chiefly prevails,  and  in many of the phenomena, to Intermit-
tent Fever, of which,  by many, it is considered as  a mere mod-
ification."  Dickson speaks thus of the two Fevers : " In low,
flat, alluvial regions, the inhabitants are subject to known forms
of disease,  varying less in their character than their intensity
and violence, according to the degree of solar heat to which
they may be subjected." The degree of solar heat is productive,
in a measure,  of the duration  of  that intermission.   Where
intense, as  on the coast of Africa, the West India Islands, Santa
Cruz, Cairo, Barbadoes, and Cumanna,  where the mean  tem-
perature of summer rises from 75° to 85° Fahrenheit,  we have
Remittents of malignant character; in more Northern, and com-
paratively  more genial climes, we find chiefly the Intermittent
Fevers prevailing.  Again Dr. Dickson observes, when on  the
subject of Bilious Remittent Fever : " We must not confound
the subject  of our present discussion with any of the other forms
of Fever—Continued  Inflammatory,  Ephemera],  Ardent, or
by whatever  names   they may  be  known.  Its  analogies in
course and  history with malarious Intermittent are, as we shall
hereafter see, very close."   To increase still farther the strength 
16
of all  this testimony, Dr. Burnett observes, that even on the
coast of Africa, Bilious Remittentpwhether endemic, epidemic,
or sporadic, if imperfectly cured, become Intermittent.
  We  pass on, therefore, to the  subject of our discourse, as  it
can now be seen that there is no error or singularity in our treat-
ing, together, those diseases of which we are about  to write—
diseases, in fine, which, though different in name, are not only
identical in type, (and, therefore, readily convertible into each
other,) but similate each other closely in symptom ;  similar in
cause ; frequently in effect; often in treatment; and always in
those remedies upon which, as well for their immediate as pro-
phylactic agencies, we invariably rely for their removal.   These
Fevers now occupy a prominent  position, as  unwelcome as to
be regretted, in the catalogue of unlimited diseases.   It is this
class which forms the chief arena in which the profession has
to struggle for the mastery; a struggle in which those about to
enter, must look for  encouragement  and  hope to  the bright
records  of the past,  to those glorious triumphs  which have
crowned the  illustrious efforts of their honored predecessors ;
and lastly, to the magnificent results of microscopic  examina-
tions, fully equalled and supported by the delicate though accu-
rate  analyses  of the laboratory.   The  microscope, the  scalpel,
and the retort, form, indeed, the medical tripod, from which the
Pythian Goddess of Research delivers to us her oracles—oracles
which command  our respect for the labors of the  past;  which
should induce our cooperation in those of the present; and rea-
soning from both, cause us to look with mingled emotions of
pleasure and hope upon the gilded horizon of the  future.
  For convenience, we will first describe the varieties, symp-
toms, and treatment of Intermittent Fever; pass on to Bilious
Remittent; and,  lastly, note the causes,  complications, etc.,
which necessarily appertain to both diseases.
  In Intermittent Fever we are struck with the correctness of
that enlarged view of disease which frequently ascribes "func-
tional and organic derangement to general and constitutional
disorder."  In reasoning as to the  nature of Inter and Remit-
tent Fevers, we argue, or infer an identity of cause, from a simi-
larity of effect; the effects being always  the same, prove a
similarity of cause.  In no one disease does the  present view 
17
of the subject more strongly corroborate the lessons of tradition.
This  Fever,  though most  generally endemic,  has not unfre-
quently been epidemic.   Where endemic, dependent, of course,
upon its  peculiar and  only  cause,  malaria.   If epidemic,
it  must be locally so ;  for we  cannot  learn that it has  ever
extensively  and regularly  prevailed where  "opposite  or  con-
trasted conditions of cold, heat, dryness, moisture, and peculiar
winds " have existed;  or beyond the  scope  of notable  exhala-
tion and favoring winds.  The contrary of all this, Dr.  Ferger-
son has attempted to prove by facts :  stating that he has  seen
these Fevers prevailing  " upon level  plains  of sand,"  and
among  those living  " upon  the  banks of pure  and limpid
streams, running through a rocky and sandy country."   It is
well for us, however, not to be  misled by such assertions; for
though true in the main, they may all be  capable of explana-
tion.  Who shall  say that these exhalations did  not  prevail,
though unknown to the examiners;  or developed in such quan-
tities from neighboring,  it may be distant sources, as to  impreg-
nate the whole atmosphere 1   We know that this agent can be
suspended in the  watery vapor of the atmosphere, and  this,
here  a  ready vehicle, is constantly moved—driven back and
forth—by prevailing winds.   How more than  probable, then,
that this poison, taken up from mephitic localities by the atmos-
phere, and thus driven before favoring winds, that the contagion
should  be deposited in dew throughout healthy and  distant
regions.   The prevalence of this Fever is in an eminent degree
dependent upon temperature.   Apart from other countries, we
see this fact proven by the winter table of the Charity Hospital
in New Orleans.
   Of Intermittents, we  have  chiefly three  divisions:  Quoti-
dian, Tertian,  and Quartan,  with meir special  peculiarities
and  complications.  Authors  have mentioned  many  others,
but of these, a large  proportion is  entirely  hypothetical, and
the small remainder rarely met Avith—the Quintan, Sextan, Heb-
domadal, Octan, Nonan, Menstrual, and even Annual Intermit-
tents : very nearly all oi them existing rather in  imagination
than .reality.  The Septiman should be excepted, as there  are
well authenticated accounts of its  fatal existence in Russia.
Not satisfied with this long catalogue, the ingenious have amus-
                                             2 
18
ed themselves by giving names to this disease, founded  on the
symptoms  which  characterize, at  times, its various divisions.
Thus we have the Pernicious, Congestive, Choleric, Dysenteric.
Kepatic, Cardialgic,Peripneumonic. Pleuritic, Nephritic, Cephal-
agic,  Diaphoretic, and Algidic, etc.,  Intermittents;  all serving
to show the ludicrous mistakes which  one  must  make who
seeks to designate a disease, not by its cause, but by the  list of
symptoms manifested in its course.
  Of the three great divisions mentioned, the second, or Tertian,
is most frequently met with.   This variety, with its complica-
tions, may be said to form a large proportion  of the  cases of
Fever which, in the alluvial sections of our country, we are
called upon to treat.  We  will, however, take them  up in order,
and as their characteristics and the history of their course have
in latter days been reduced almost  to a formula, dispose of them
as summarily as possible.
  First, comes the Quotidian.  This variety completes (as the
name would imply) its revolution in twenty-four hours—appears
always in the forenoon, seldom invading before daylight, or du-
ring sleep, (differing here so remarkably from Yellow Fever,) and
rarely after 10 or 11 o'clock.   Its cold stage is shortest, hot stage
longest, (say ten hours,) and  apyrexia very trifling.   The Quo-
tidian is the most severe form, lasting  doubly as long as the Quar-
 tan,  and its apyrexia least  of all.  Some authors have  given
 twelve hours as the time in which the  paroxysm is completed; this
 we would suppose under the  mark, and think fourteen to sixteen
 hours more nearly correct.  The Tertian attacks at noon, and is
 usually terminated the same evening; completes its revolution in
 forty-eight hours: average duration of the paroxysm six to eight
 hours.  The Quartan attacks in the afternoon ;  cold stage very
  long ; paroxysm very short, and rarely exceeds four to six hours ;
  completes its revolution  in seventy-two hours ;  supposed to be
  the  most tenacious.  " The  Quartan has the longest cold stage
  and the shortest paroxysm ; the Quotidian the shortest interval
  and shortest cold stage, but the longest paroxysm."  The Ter-
  tian holds an intermediate position in the duration  of its stages.
  "To express these  facts mathematically, the  length  qf the
  paroxysm varies inversely, as the length of the cold  stage;
  inversely, also, as the  length of the  interval."   These sepa- 
19
 rate  types  usually  observe  a distinctive character throughout
 their course, though it has been said that either or all of them
 may lapse into the  Quartan form.  Besides these simple varie-
 ties,  we have their complications, chiefly relative to the Tertian
 and Quartan forms.   Thus, when we have an attack every day,
 "distinguished from the Quotidian by the time of its access and
 duration of the paroxysm,"  it is called the Double Tertian or
 Tertiana Duplex.   This form may readily be recognized by the
 similarity existing in the paroxysms of alternate, and the dis-
 similarity which characterizes those of successive days.  Again:
 there is a form in which  we have two paroxysms in forty-eight
 hours,  but  these two occurring  on the same day :  this is styled
 Tertiana Duplicata.   Of the Triple Tertian we have two varie-
 ties also: Tertiana Triplex, in which we have three paroxysms
 in forty-eignt hours,  two on the first, and one on the second day;
 and Tertiana Triplicata, which exhibits the same number of par-
 oxysms in forty-eight hours, but three of these dissimilar in nature,
 occur on the first, and no paroxysm on the second day. This last,
 form is mentioned, we believe, only by Hossack, and in  the past
 Summer we saw a very well marked instance of it, in the person
 of a young man residing on Cooper River.   It proved to be ex-
 tremely  tenacious in character,  resisting all the anti-periodic
 remedies administered by the attending  physician. As it is a
 form  so entirely rare, we will digress a little, for the purpose of
 a brief description.   The patient, on every alternate day,  was
 attacked by the three well marked and violent  paroxysms, each
running distinctly through the several stages.  The first attack
usually came on a short time after daylight, lasting until 10 or
11 o'clock; the second, some time during the afternoon, usually
between 3.and  5 o'clock ; and the last  about  bed time.  The
paroxysms were all of the most  violent character;  and the dis-
ease,  after resisting all medication, was terminated only by the
cool weather of Autumn.  The patient was reduced to a skele-
ton, jaundiced, and with an extremely large spleen.  He recov-
ered slowly, and with extreme difficulty.   An elastic and robust
constitution  alone saved his life.
  We pass  on, next, to the  Quartan form of this fever.   Dr.
Cleghorn, in his work  on the Diseases  of Minorca, gives us
instances of the Quartana Duplex, Quartana Duplicata, Quar- 
20
tana Triplex, and Quartana Triplicata.   We are told, again, of
a Semi-Quartan, etc.   These  forms we seldom or rarely meet
with in our country,  and  any description could only be given
from foreign authorities.   The simple Quartan  is common,
and this is the most tedious and difficult of cure.   This being
already described, we will omit  its various and hypotheti-
cal complications, and  next take up  the  symptoms  usually
characteristic of intermittent, as a class.   After the termination
of the  period designated  as that of incubation, the patient is
first  sensible of muscular  debility and mental  apathy; then
comes on a distress in the epigastric region, listlessness, thirst and
disinclination to either physical or mental exercise,  sighing and
stretching of the limbs, and sensation  of cold water trickling
along the course of the spine, the blood deserts the surface, and
becomes inwardly congested, the cutaneous capillaries anamiic,
we have what the books term  cutis anserina, horripilatio mani-
fested ; the features shrink, and the patient complains of intense
cold ; then  comes on the convulsive shaking  of the body and
limbs,  the teeth chatter, (some authors say, so  violently as to  be
shaken out of,) or broken  in their  sockets, the nose is pinched,
lips and nails become blue, respiration disturbed, quick and hur-
ried, pulse slow and  feeble, pains in the head, bones and exte-
rior muscles of  the  limbs, secretions suspended, (though the
bladder is sometimes  irritable  and its  contents passed in lim-
ited  quantities, "pale and aqueous,") tongue usually dry and
white.   This, the cold,  or algid  stage, lasts for some time
and its duration, of course, characterizes the form under which
the patient labours.  The coldness now either gradually or sud-
denly  ceases; we have occasional flushing,  alternating with
spasmodic chill;  the blood becomes again centrifugal  in  its
course, the  cutaneous capillaries resume their action, and the
skin returns to its normal  condition.   This state does not last
long; for we have the law of action and reaction manifested,
inasmuch as the whole  circulation and system was depressed
so is there now a proportionate excess of action: the face and
whole  surface takes on a  roseate hue, becomes turgid, hot and
dry; sometimes this heat  is excessive, and v/e have the ucalor
modax " of the old writers: the eyes become suffused, the pulse
full, frequent, bounding and strong, occasionally immaterially 
21
 intermittent, violent cephalalgia, the respiration becomes slower,
 but  deeper, and causing great depression, secretions entirely
 suspended, and the patient extremely anxious and uncomforta-
 ble.   This is  denominated the hot stage, or expansive stage of
 Dubois.  This state, which causes the most  suffering  to  the
 patient, passes gradually into the last, or sweating stage:  the
 skin becomes  soft,  relaxed, and  a copious perspiration breaks
 forth, the thirst, so tormenting in the previous stage, ceases, the
 secretions are  all resumed, the tongue is soft,  pulse  is natural,
 pains lost, and the patient  expresses  himself  as entirely well
 again.  This, however, is comparative, for there is that peculiar
 condition impressed upon the patient by  the disease which we
 term Intermission, a state in which the patient feels that he is
 not entirely well, and which has been said at times to be so well
 marked, that an acute and intelligent observer can by it predict
 the recurrence of the disease.  This feeling the patient cannot
 himself describe ; it has never been done satisfactorily or intelli-
 gibly in the books; yet it is familiar to every one who has expe-
 rienced or closely observed this  form of disease.  We have not
 in our  language words  to describe it,  the peculiar  uje ne sais
 pas quoi" of  the French is all that can be said of it.
   In considering these varieties of Intermittent,  we should care-
 fully avoid the old error, of considering  diseases as separate
 entities, but rather look upon them as merely " modes of being
 and acting different from those which are proper to the state of
 health."   The  older writers  give  us symptoms separate and
 distinct as characteristic  of peculiar forms.  This  we would
 consider as tending too much  to complicate an otherwise simple
 diagnosis ; thus Wilson gives us the history of cases, as reported
 by Cleghorn, Senac,  Frank, Jackson, Vogel, Burserius, Sohen-
 kins, Stork, Pringle, Clark, Galen, Rush, and a host of others.
 Symptoms, or varieties, which should essentially form a part in
 the medical history of the disease, but which are not sufficiently
 uniform to be  considered as diagnostic in a work on  practice,
 where anomalies arise, they, of course, complicate the treatment,
 and may obscure our diagnosis ;  but as it is utterly impossible
 to classify by symptoms, so as to give these so completely and
thoroughly that each case met with shall have its analogue de-
scribed  in the books,  all that  can be done, is to give the usual 
oo
symptoms; and where others are manifested, we should be pre-
pared to treat the causes, of which  wo see but the effects, on
general principles.   Apart from the usual symptoms, we would
remark, that those characteristic  of the typhoid  form—viz:
great muscular prostration and  deficiency of  vascular action,
nervous derangement, " low muttering delirium, mental dejec-
tion, alarm"—are at  times met with, particularly among  the
negroes inhabiting the alluvial sections of our  State.  In  all of
our malarious fevers, whether preceded by chill, or not, we have
the centripetal congestion of a passive character, and a conse-
quent reaction totally  unintelligible, unless this fact be known.
There is, in the cold stage  of an Intermittent,  positive cold, as
the blood has been found as low in  temperature as 75° Fahren-
heit ; on the contrary, the heat, in the next stage, is comparative,
(the patient deluded by the contrast,) seldom over 100° Fahren-
heit.   In the cold  stage,  the extreme depression under which
the patient  labors is now considered in character entirely neu-
rotic, attributed either to want of action, or its peculiarity in the
cerebro-spinal system ; while the dyspnoea of this stage is entirely
due to congestion of the internal viscera, pulmonary congestion,
it would seem, being always  excessive.  The  neurotic depres-
sion, in the cold stage, would seem to be the direct action of the
poison of malaria ; and one is somewhat supported in this view
of the subject,  by the effect  of stimulus on the system:  as  in
poisoning from the bite of a venomous reptile, or  animal, stimu-
lus produces no longer its normal and usual effects on the vas-
cular system, so in the cold stage of this disease,  the greatest
amount of stimulus induces no increase of the vascular reaction
developed in the succeeding stage.  After having  several attacks
of Intermittent Fever, there are not  unfrequently  symptoms
manifested, on the recurrence of a  paroxysm, eminently calcu-
lated to mislead us. Thus, we are told of a lad yon the " Neck,"
who suffered repeated attacks of this Fever during the summer:
the Fever was  checked;  but there supervened, at the  usual
time of its access, periodic attacks of vomiting: the case being
properly diagnosed, this  annoyance was speedily checked by
the administration, in the ordinary manner, of quinine and other
antiperiodics.  Again, of a case of a man  who contracted an
obstinate Fever of this form, on one of our rivers: the Fever was 
23
 speedily made to yield;  but, for some time after, he was attacked
 with periodical sweats.   This case was managed  and treated
 as successfully as the first.
   Before considering the treatment, we would bear testimony to the
 truth of the prophylactic agency  of quinine, one well marked
 case having come under our observation during the past summer.
 The patient  manifested  most decidedly all of the prodromic
 symptoms of an attack  of this Fever; but being promptly placed
 under the ectrotic quin ine treatment^ ven before having recourse to
 the  usual and previous cathartic, or aperient course, was quickly
 and permanently relieved; having no return of the disease through-
 out the remainder of the season.  The history of the case was one
 of extreme interest, but we have not  room here to introduce it.
 We are firmly persuaded, however,  that after having been ex-
 posed to the cause of the disease, if any one will adhere rigidly
 to the prophylactic treatment, viz:  full and regular use of qui-
 nine, the avoidance  of exposure, and all the predisposers to
 Fever,  using at least no less of an accustomed  stimulus, the
 disease may either be warded off, or made to abort  entirely.
 We believe that quinine is fully as valuable and efficient  in the
 precursory as in the incipient stage.
   Perhaps in the history of no disease, have there been  as many
 and various theories offered, as to the various indications which,
 by  the  action of our medicines, we  are called upon  to fulfil.
 Happily the long list of theories, as well as of medicines, has
 been curtailed, and our  treatment now is reduced to the simplest
 and most intelligible  form possible.  We find here, on the com-
 paratively unexplored ocean of Therapeutics, the needle of the
 magnet, not unfitly prototyping that of medical science: as the
 one, vibrating and  oscillating between the opposing  forces of
 natural  and physical  laws, finally settles to its pole, so the other,
 quivering and changed by every breath of opinion, no less surely
 rests at last, and as unerringly guides us on our way.  Mighty,
 and  always to be relied on, we would say of it, " Veritas magna
 est et semper prcevalebit."   We have but to cultivate, diligently
 and  conscientiously, the  field  in which we are  called upon to
 labor; to banish imposition and  presumption from  the pre-
cincts; to fulfil the  command, "Physician heal thyself;" and
our course must  be ever  and still brightly forward. 
24
   Treatment.—We may  say,  generally,  that during the
 paroxysm this should be palliative and protective ;  during the
 intermission, preventive  and  alterative.  It is undoubtedly best
 that we should resort to the mildest means, for often these are
 alone sufficient: if so, we save the patient much suffering; and
 if not, we can in time, resort to  the more  active, or, perhaps,
 heroic remedies.   Our interference by drugs is only warrantable.
 when their  action becomes a minor evil to the disease itself;
 and we should always be careful that the action of the disease,
 relative to the strength of the patient's constitution,  be closely
 interrogated, before instituting a  harsh and painful medication.
 Our practice  has, during later years, been much modified in
 this respect, and justly so ; for Homeopathy has taught us that
 unassisted Nature is  alone capable of successfully combating
 the  attacks of disease.  Years ago 'twas  said, that, if on an
 accidental loss of the aqueous humour of the eye, the patient
 would only for a given time cover that organ with "a buzzard's
 wing," the  wound would be healed,  and the humour restored.
 This being successfully done, theory was rife for the  scientific
 explanation of the phenomenon, until it was casually discovered
 that the same effect would be produced without a resort to the
 mystic agency.  Thus it is with  that specious piece of empiri-
cism which its professors  have attempted to dignify as the "Sci-
ence of Homeopathy."  Let  us, then,  be always sufficiently
eclectic to profit by even the errors around us.
  If the cold  stage has  not fairly set  in, we  may try the ec-
 trotic treatment of opium in some of its forms.   This, in com-
 bination with some of the strongest stimulants, will be our only
 hope in preventing the accession on so short a notice.   If, how-
 ever, we do not see the patient, as usual, until in the cold stage,
 the opium  may still  be  given, as it will abbreviate, at times,
(Trotter says, always,) this part of the paroxysm.  The warm
bath, or the pediluvium,  may be used ; either will add to  the
patient's comfort.   External warmth applied either by increased
 bed covering or by hot bricks, bottles of hot water, bags of  hot
 salt, etc.; warm diluent drinks  will be fancied, and may be given.
 One of the authorities tells us, " Give warm drinks in  the cold,
cold drinks in the hot, and tepid drinks in the sweating stage."
 If we suspect a foul,  or  loaded condition of  the  stomach, an 
25
emetic may be given with great advantage, as not only is the
first indication thus fulfilled, but the act of vomiting causes a
centrifugal distribution of the blood, tending thus to prematurely
induce  this,  its condition, in the hot  stage.  In  addition, we
have  gained, thus,  much time, and the system  is in a better
condition for after treatment.   Emetics, however, need not be
given, unless this state of the stomach be observed; when pre-
scribed, the mustard and salt, or scruple dose of Ipecacuanha had
better be given ;  Antimony and the prostrating emetics should
rigidly  be  avoided.  Though Mcintosh, Twining  and Reid
speak so highly of venaesection at this time, still their testimony
is more than  negatived by the  experience of Stokes, Gill, Town-
send, Law, and many others,  all equally high and respectable
authorities.   This  practice is,  for the most part,  now pro-
scribed  unless in the forms exhibiting extreme congestion,
where  it  may be demanded.   Yenaesection,  on the whole,
is seldom,  or never  required, and  milder treatment will often
equally well   fulfil the indications.  Again,  the experience of
many now  recorded, teaches us that  the use of the lancet is
not unfrequently  dangerous: these diseases, occurring as they do
in Summer, find the constitution in an atonic state,  depressed by
the combined effects of the heat and season.   This last inculca-
tion is,  however, as old as Hippocrates; for one of the doctrines
advocated in  his treatise on regimen is, that "the quantity of blood
drawn should be  in proportion to the constitution  of the body.
the season,  the age, etc."  When the lancet is used, however,
the blood should  be drawn from  a large orifice, as thus shall we
speedily create the greatest impression with the least loss.  The
patient should generally be  seated upright, as this  also tends to
increase the  advantage.   Nothing  more need be  done in this
stage ; for here, at all times, a needlessly officious practice is not
only  injudicious,   but absolutely useless, and it  may be dan-
gerous.  Some authorities recommend  the  tourniquet practice
of Kelly.  There are favorable accounts in regard  to it;  but
generally, it is but little used.  Next comes on the hot  or expan-
sive stage.  Here still less is required of us;  for the cold stage
passed, and with it much of the danger, (for in this disease the
danger is peculiar  to this stage,) the paroxysm progresses to a
speedy solution.   We should see that our patient have but light 
26
 covering, free ventilation  and cold drinks ad libitum;  some
 refrigerant diaphoretic may be  given.   Free sponging may be
 instituted, or what is still  better, the much neglected practice of
 Dr. Currie,  ablution, or affusion.  The patient, though at first
 shrinking from the shock produced by the cold water, will, after
 experiencing its grateful and beneficial effects,  soon  crave its
 speedy repetition.  At  times we may meet attacks of the Ty-
 phoid  character: here the patient passes,  with difficulty and
 much danger, through the cold  stage, and reaction  takes  place
 but  feebly  and imperfectly.   Our  sole  indication here  is to
 stimulate heroically: and,  as in other  cases,  if dangerous
 congestions are manifested,  to combat them on general  prin-
 ciples,  frictions,  counter-irritations,  contra-stimulant use of qni-
 nuie, etc.  Where reaction takes place,  and  threatens  to  run
 to a dangerous extreme, the lancet may  be  used beneficially.
 Of course,  we have no  reference here,  whatever, to a  Ty-
 phoid attack, as this  practice would most generally  be fatal,
 though it has been  tried and advised.   The cold  ablution, or
 affusion, should, if at all, be  used with extreme caution, if the
 patient  be cold,  feeble, incapable of reaction, or  suffering  from
 pulmonary disease.  The sweating stage needs  no medication,
 as it is the spontaneous and natural solution  of  the paroxysm.
 The patient should avoid currents of cold air, drink sparingly
 only of cold water;  and ablution,  etc., should, of course, be
 proscribed.  It has been thought best that we should now com-
 mence  the anti-periodic treatment, as  the effects of the agents
employed are most conspicuously manifested sixteen, or eighteen
 hours after its administration.   Quinine (the disulphate) is most
commonly used ; six, or eight grains may now be given.   There
 is, however, much variety in the  preparation of quinine  here
 given:  the acetate, citrate, ferrocyanite,  muriate, nitrate, phos-
 phate, valerianate, disulphate, etc.   The  disulphate,  if selected,
may be given in a glass of water, with one or  two drops  of sul-
 phuric   acid, to bring it in solution.    We  may  now  give
some  gentle cathartic,  in combination with  a few grains  of
calomel; or, we may give the  last alone, and the cathartic a
 few  hours after.   It is  only necessary to act gently and effec-
 tually on the gastro-intestinal canal; after which, our attention
 should be directed  chiefly to the anti-periodics.  During the 
27
apyrexia, the patient should be kept under the influence of these
remedies.   As the time approaches for a re-invasion, there is no
one remedy of more importance than opium:  we  thus  induce
sleep, a sure and infallible prophylactic.  Emetics, as prophy-
lactics, are sometimes prescribed ; but this practice is harsh, and
unnecessary.   Invasions have  been repelled by appeals to the
sympathies:  thus, cobwebs, spiders, and other  disgusting nau-
seants, have been administered.  Deception has  been success-
fully practised, and the old and well known trick of moving
" adroitly forwards the  hands of the clock," has often  caused
the patient to  forget that he must have his chill.  There is a
tendency to anticipation of an attack, and this may, it is thought,
be in a measure  causative—external irritation  producing peri-
pheral distribution of the blood, and thus preventing that inward
congestion which characterizes the chill.  Phloridzyn, obtained
from the bark  of  the apple tree, "and cetrarin, from the cetraria
islandica," are among Dr. Dunglison's new remedies.  Sulphur
has  been found  very  effectual—dependent altogether  for  its
beneficial effects  upon its tendency  to excite the  hepatic secre-
tion.  The etherial acetated tincture of iron, called by Dunglison
entropic, has been highly recommended.   Many of these reme-
dies may be administered endermically.  We have recently had
favorable accounts of the gossypium herbaceum, or cotton seed,
from  Dr.  Peterfield Trent,  of Richmond, Virginia.  He thus
prepares and uses it: Place 1 pint  of cotton seed in 1 quart of
water; boil to a  pint—1 gill  to be taken one hour previous to
the expected chill.   This is preceded by calomel, or some mild
cathartic;  and the practice, so far,  is said to have been highly
successful.  Citrate of iron and quinia,  and  combinations of
opium with quinine, are favorite prescriptions at  many of the
public institutions.  Arsenic  was  once  a prescription  held in
high esteem ;  but it is now  being abandoned.   In the opinion
of Dr. Hunt,  of  England,  who has taken much pains to ac-
cumulate testimony on  this subject, it is not to be relied on.
This is, we believe, fast becoming  the  opinion of most practi-
tioners in this country.   When arsenic is given, Fowler's solu-
tion is usually preferred; it had best be given in  stationary or
diminishing doses:  given to  excess, though not  in  sufficient
quantity to produce its toxicological  effect,  it produces a cachexy 
28
not easily removed.  The success of arsenic is dependent upon
its alterative or eliminative ("this word should  be  used, as it
expresses the real action of the drug," ) effect.  This medicine
has been known to reproduce the disease, irritating the gastro-
intestinal mucous membrane, creating thus a centripetal action
of the  blood;  the  cutaneous capillaries become  emptied, and
chills supervene.   We have heard one case of this  kind reported.
When quinine is given, it should be continuously, as it is rapidly
eliminated by the kidneys, and can be detected a few hours after
in the  urine.  The  action of this salt is now thought  to  be
entirely catalytic.  The stomach frequently revolts after quinine
has been given for some time.  When this is the case, by com-
bining  it with piperin, its disagreeable effect will be removed.
Cinchona is superior to the salt of its extract in tonic property.
In the  first we have tannic and gallic acid combined with the
anti-periodic agent;  in quinine, only  the last.  This anti-peri-
odic element is alkaline in reaction, and it is in  this way that
we may explain its speedy elimination by the  kidneys.   It  is
arbitrarily determined that 20 grains  of quinine should be our
maximum dose; its good  effects are  not increased proportion-
ately if  at all  beyond  this  quantity.   Quinine  was  once
forbidden until there was complete apyrexia; it is now given fre-
quently in the second and third stages.  There are many reme-
dies of minor importance  mentioned  in  the books:  narcotine,
piperin, salicine, cornine, poplar and magnolia bark, quassia,
gentian, the vegetable and mineral astringents, etc.  There are
many and valuable salts of iron now commonly  used : citrate,
prussiate, carbonate, etc.   The  Ferro cyanuret of iron  is
beyond estimation valuable,  and may yet usurp the place
of cinchona.   It produces the effects of quinine, without the
cerebral  disturbances occasioned by  the latter.   Dr.  Zollic-
koffer,  of Maryland, deserves the thanks  of the  Profession,
for  its  introduction.   Petrequin  has  recently  furnished  us
with the  recipes  for many new and effective anti-periodic pre-
scriptions and tonic  agents:  manganese and iron, effervescing
solution of manganese  and iron, carbonate of iron and manga-
nese, ferro-manganic chocolate, lactate of iron and manganese,
some of  the salts of copper,  zinc, bismuth, etc.   The prepara-
tions of iron and manganese have recently received particular 
29
attention, and are highly advised.  Muriate of ammonia should
here be mentioned, as it  has succeeded in reducing a hypertro-
phied spleen, after quinine and other remedies have failed.  It
will be often  found, however, that a case of Intermittent Fever
will resist all of our remedies, and yield only to the beneficial
effects of travel,  change  of our occupation,  etc.  In one case
that came under our notice during the summer of 1852, all of
the usual remedies were tried in vain ; the cold of winter proved
ineffectual, and the tenacity of the disease was only conquered
by  the patient's having exposed himself and contracted a vio-
lent pleurisy.   There  was here, enlarged  spleen,  anorexia,
oedema of  the extremities, and general cachexy.  The blister
applied for the pleurisy conquered both diseases.
  Postponing diagnosis, prognosis, causes, etc., we  proceed now
to consider
            BILIOUS REMITTENT FEVER.

  The  causes  and history  of this  disease have attracted no
small proportion of the attention of  physicians, from the era of
Hippocrates (who graphically  describes it in  his  treatise on
endemics) to the present time.   It is the disease which country
practitioners, in the Southern sections of the United States, are
chiefly called upon to treat,  and which has, in some of the fatal
years of its history, robbed many a  hearth-stone  of its  orna-
ment, destroyed  the  happiness of  many a  community, and
made desolate many a village.
  We shall  say nothing of its history  in our own State, for this
alone is sufficient material for a volume, but pass on immedi-
ately to  its  description.  To the derangement of  the  hepatic
function  and secretion, which, being  so uniform, has given in
part a name to this disease, we will briefly allude.   The causes
of this derangement still  remain in obscurity;  and though Dr.
James Johnson has offered,  in his work "on the liver," many
arguments  in favor of what he  terms  " a cutaneo-hepatic  sym-
pathy." still these views, though at  the  time received  with
respect and interest, have, from the rapid strides of physiology
lost much of their value.   The physiology of the liver,  though 
30
comparatively still obscure, is so much better and satisfactorily
understood, than was the case when he wrote, that many of the
views, predicated on  this knowledge of the  organ, have since
been abandoned.   That this sympathy does exist, is even  now
generally admitted;  but  his explanation of the cause of this
effect is, in many  respects, controverted.   The history of the
residents of India,  and ot all  hot climates, proves that  this
sympathy does exist;  but Dr.  Johnson's  explanation  of  this,
that " the contemporary action in any two organs will, in time,
produce such an association that, when the impulse is given to
one, the other will act by what is called  sympathy," though
very ingeniously and elaborately  defended,  (we can not say
supported) is entirely illogical.   The fact of this sympathy, be
whatever may the cause, is  undoubted.  Taking  for granted
that high solar heat does increase the  activity of this gland, in
process of time deranging its functions, with,  at the same time,
a glance at the part which, in its normal condition, it is called
upon to play in the animal economy, and we shall readily com-
prehend why it is, that during our  Summer months the Fevers
peculiar to them should be so modified in course and history,
as to be designated by a word which we receive, as intending to
imply a serious derangement of the organ in question.
  Let  us take a glance at the  physiological facts  now estab-
lished  in regard to the  liver;  and  we can  at  least compre-
hend the  effect,  if  not the cause,  when its  functions  are
obstructed, impeded, or deranged.  It  is clearly proved, that in
the nourishment of the  blood,  and thus of the whole system,
the lacteals  only take up the oleaginous portion  of the non-
nitronized-ingesta; that this is  converted  into  the  true chyle,
being,  until it has  passed  through  the   mesenteric glands,
little more  than a fatty  emulsion ; that  in the thoracic duct
this comes in contact with a fluid  lymph (elaborated from the
arterial system just before it merges into  the venous radicles,
and thus proving its still vivifying  power,)  whose whole func-
tion is to modify and fit it for introduction  into the circulation ;
that the other portions of the food, in the  form  of sugar, dex-
trin, gelatin, etc., are taken up  by venous absorption ; that the
branches of this venous tree unite to form a  common trunk
which, under the name of the vena portae, passes directly into 
31
the liver, holding in suspension all of the nutriment destined to
the support  of the  system, the small portion taken  up by the
lacteals being excepted:  here it is for the time  lost;  but the
analysis of the chemist teaches us that this important  gland is
not idle : the blood of the  hepatic veins, as compared with that
of the vena portae, now shews " an increased  proportion of
sugar and fat, which are  generated from its other components
during its passage through the liver;  "  and there  is a decided
augmentation in the quantity of fibrin : the blood then passes
onwards ; the effete matter contained, is first  attacked by the
lungs, and  partly eliminated ;  the new matter taken in is now
here vitalized ;  the blood next enters the circulation, and what-
ever  of  effete matter  then remains, is then  removed by the
remaining eliminative organs  of the body.  Can any one be
surprised at the Protean diseases, and modifications of disease,
which are manifested to us, when this important organ is injured
or deranged ?  For a time, thwarted by extraneous, or extrinsic
causes, venous absorption is injured; alimentation stopped; the
blood altered  and impoverished by this detraction of those ele- !
ments which form so conspicuous a part in its genesis ;  debility
and depression are produced,  thus increasing the susceptibility
of  the system to the invasions of disease;  the action of zymo-
sis, in its many forms, on the blood is favored; this  becomes
poisoned ; nervous prostration succeeds, and disease supervenes.
This  may  be somewhat Utopian;  but we  are, nevertheless,
deeply impressed with  the  truth of the rationale thus offered.
   We pass on. now, to the symptoms manifested in this Fever;
 and  shall observe a marked coincidence  between them  and
 those developed in the previous disease—differing, as they do,
 mostly in  degree.  The symptoms of this Fever are, as we
have  said,  very similar to  those of the last; the chill is not
 usually as  well marked ; the gastric uneasiness a little more  ;
 the pulse is somewhat peculiar, after reaction has taken place
 being exceedingly quick, frequent and jerking; the tongue is
 coated with a yellowish fur, which increases in thickness  and
 depth of hue,  or shade,  as the disease  advances, sometimes
 swollen  and indented;  the irritation  (this word has  recently
 been suggested  for the old word irritability, this last expressing
 a property of the stomach in its natural and healthy condition,) 
32
 of the stomach  increases, and we have  nausea and vomiting.
 This last symptom has been urged as a  reason  for considering
 this state as dependent upon a neurotic cause, and the anorexia,
 nausea, and vomiting, have been attributed to the sympathy of
 the  pneumogastric nerve in the  general neurotic  disturbance.
 The matters  thrown up are  usually the ingesta, mixed  with
 mucus, and very soon with  bile.   " There is some  relief  after
 such vomiting,  but  the organ continues disturbed, oppressed,
 and uneasy:  cephalagia, of  intense character,  usually  now
 supervenes ; the bowels become constipated ; there is jactita-
 tion and pervigilium ; the alvine evacuations differ so  con-
 stantly in consistence, appearance, etc.,  that they  can not be
 considered as at all pathognomonic ;  the  swollen tongue shows
 that the secretions are abundant and vitiated, while its darkness
 and dryness betoken danger; sometimes the urine shows an
 albuminous deposit, easily detected by  subjecting this secretion
 to heat, etc.  The disturbance of the circulation is attributed to
 nervous derangement, for a correct nervous influence is neces-
 sary to a healthy circulation—destroy one, and you destroy the
 other.  These symptoms last proportionately with the intensity
 of the disease, varying from six  to twenty hours; a remission
 now takes place, and the patient experiences extreme relief.  The
 cutaneous exhalation well manifested here, is extremely favora-
 ble.  As  to the duration of these paroxysms, we will find them
 bearing a close  analogy to  some of  the  forms of Intermittent
 Fever: this is  so uniformly the case as to be generally known
 throughout the country ; the good and bad days are  proverbial.
 Some authors mention a semblance in the course of this disease
to the Triple Tertian.  This "herosthesis " (peculiar to what
is known as "country fever")  is extremely  dangerous; but,
happily, comparatively rare.  The remission lasts, also, in pro-
 portion to the intensity of  the disease  and the peculiar form
 which it similates.  When the exacerbation again  comes  on,
there is  a return of most of the preceding  symptoms, either
 diminished, or aggravated in intensity,  as the disease be of a
 mild, or virulent form; if the first, the patient gradually looses
his fever, and  progresses rapidly to convalescence; if the last,
 manifestations of danger are  speedily exhibited;   tenderness
 about the epigastrum, increased sensibility of the eyes to light, 
33
restlessness  and  vigil.   There  is  great  anxiety, fretfulness,
despondency; the pulse  looses somewhat of its fulness, but is
still tense, frequent, abrupt.   The tongue assumes a dark  hue,
and the thick brown fur is even blackish along the central line ;
it is often dry, chapped, or  cracked.   The  bowels, sometimes
costive, refuse to yield ;  at others, tormina and  tenesmus annoy
the patient, with stools frequent, thin, offensive, or acrimonious.
generally exhibiting a diminution, or  absence of the biliary
secretion ;  " respiration becomes embarrassed;  there is  great
debility."  In a few more paroxysms  the constitution yields;
lesions  occur  in  some of the important  organs; prostration,
general and complete, comes on ; the pulse,  gradually sinking,
becomes thread-like, quick,  frequent,  and  weak;  subsultus,
colliquative  sweats, floccitatio, hiccough, tympanetes, low mut-
tering, delirium, supervene, and death closes the scene.
  The duration of the disease varies from " seven to thirteen
days," though there is a general prejudice among the common
people, that the ninth is usually the  critical day.  This last
cannot be determined or stated;  as  almost every day, from the
seventh to the  twenty-fifth,  has  been  given, as that  on which
we are to expect a crisis in this disease.  This is manifested in
various ways;  but most generally by copious cutaneous trans-
piration.  The "critical  sweat"  has been much dwealt upon;
but we are disposed to regard it "as rather the index, than the
cause  of a  favorable change in the  malady."  Among the
natives and  the  acclimated  this form  of Fever is not unfre-
quently  lengthened  out interminably,  as these diseases " pave
the way to their  own recurrence"  and each attack increases
the suscepi\bitity to a repetition of it; yet the virulence of the
disease is, in these cases,  notably diminished.  Of two  per-
sons exposed  to  the causes of Fever,  the one a stranger, the
other acclimated, the last will be more generally attacked, but
with a milder form of the disease, while the first may escape for
a length of time;  but when attacked,  the  Fever will be of the
most virulent character, and  the chances of life immeasurably
against him.   When this Fever does not terminate as before
mentioned, it most commonly passes  into the Typhoid form.
The remissions and exacerbations  are now less marked;  can
generally scarcely be distinguished.  The patient may continue
                                              3 
34
in this state for a surprisingly long space of time, getting neither
better nor  worse.  Cases  of this kind not  unfrequently last,
from thirty to fifty days.   The  stomach  now becomes quiet;
the tongue, lips and  teeth, covered with a thick and tenacious
sordes, dry and chapped.  Some authors tell us that the tongue
now becomes clean, fiery red, and dry; (?) stools are dark and
offensive;  meteorism and tenderness of the abdomen, on pres-
sure, are now observed (this meteorism should be closely diag-
nosticated : it  may be pneumatosis, or exosmosis of air from
the intestines into the peritoneal sac—this showing the impair-
ment of vitality in the animal  membrane is an  unfavorable
sign—or it may be tympanetes, in which  our prognosis would
not be as grave,) very conspicuously.   We have now hiccough,
(may not this be here explained by the fact, that the phrenic
nerve, in its downward course, receives, where it passes near
the chest, a filament from the great sympathetic,) " nervous tre-
mors, and perpetual subsultus  tendinum;  the countenance
becomes heavy and dull, with a  disposition to heavy stupor; "
delirium supervenes, with low fatuous  muttering;

          ///              " the life of all bifrblood ^W
         /Vl Ia Is touched corruptingljr; and his pure brain
           \J  Doth, by the idle comments that it makes.
              Foretel the ending of mortality."

This is  the ordinary course of this disease.  At times we have
what is termed the " Congestive "  form manifested.   This is no
new disease, but a simple variation in the course of the origi-
nal Fever.  It is well marked, and known to every physician
in the Southern and South-Western country.  We have here
almost  the reverse of the  symptoms manifested in  the  ordi-
nary Inflammatory Bilious Remittent.  The  contracted pulse ;
embarrassed and oppressed respiration ; thirst  and complaint
of heat  with cold surface, and profuse sweating; face livid;
vertigo; insensibility to pain and  danger:  This last sign  is
most foreboding; for  it shews that nervous  action and  sym-
pathy are  entirely destroyed: it  has deceived many  a phy-
sician, in  common with the friends and  family.  We should
always  bear in  mind  that  there  is  no  pain in the palsied
limb; that the consumptive speaks  of life when, in his cheek, 
35
brightly and ominously burns the spot that  is the herald of
death.  The abdomen,  tender  on pressure,  is but  the pre-
cursor of colliquative diarrhoea ; the remissions  are no longer
perceptible ; the patient, becoming gradually  more inattentive
to impressions and  objects around him, sinks  into  a profound
coma, the usher of death.  At  other times we have  the case
still more complicated;  and the "Malignant" Remittent is pre-
sented to us.  " The skin is cold, and covered with a clammy
sweat;  pulse weak and fluttering; stomach irritable, with inef-
fectual  and painful efforts to vomit;  countenance pale and
shrunken,  or livid; low delirium, with muttering, shivering,
and fainting.   In  some  cases, no  complaint;  again, low  cries
and groans from the miserable sufferer.   The vital powers are
speedily exhausted ; the third, fourth,  or fifth exacerbation end-
ing the distressing scene."  There are other and various anoma-
lies, the varieties defying description;  but we  have  only  to
adopt with each and all of them the advice given us by Rush,
to treat symptams as they arise.
   We pass on  now to an important part  in the history of the
disease—Treatment.   Where there is nausea, with foul tongue,
etc., we had best administer a mild emetic: this will  answer
every purpose ;  and we save the patient the depressing effects  so
characteristic of the mineral emetics.  An  advantage of much
importance is gained by the administration of  ipecacuanha,  as
it  is generally admitted  that this drug  promptly promotes the
suspended biliary secretion.  It is more than probable that any
emetic would effect a similar result;  but the harsh should be
proscribed, and  we have no better mild.  An English physician
of high  distinction,  thus writes of the mineral emetics :  " These
preparations have  sometimes  the  effect  of producing  intense
headache and prostration :  they are not admissible  in the dan-
gerous forms of Fever; while in  those which are mild they
are not required."   The remarks were made more particularly
in reference to the different forms of antimony.   There are
idiosyncrasies which forbid the  use of antimony;  and as we
may not make this discovery until extreme injury is done to the
patient,  a safe  rule would be  to avoid this entirely.  This  is
extremely advisable with negro patients; as the  feebleness of
reaction in this race, from any depressing agent, is  proverbial. 
36
So marked is this, that many  physicians are slow to use the
lancet with them in even the acute stage of  Pleurisy.  As soon
as the fever  is at its maximum, the cold bath, unless contra-
indicated, will be found of the happiest benefit.  Generally, we
need place no restrictions on the  patient, or attendants, in the
use of this valuable agent.  It is said to  be almost sufficient, of
itself, to control this disease.   Whether this  be true or not, it is
one of the oldest and most valuable remedies known  in this
country.   We are cognizant of the fact,  that an obstinate con-
stipation, which  has  defied the influences of our most  drastic
cathartics, has been, and may be relieved, by the sudden  dash
of cold  water upon the extremities.  Americus Vespucius  is
said  to have found this practice prevalent among the aborigines,
and its good effects have never since been controverted.   Ablu-
tion,  or affusion,  are either admissible ; the first, most generally
used in the earlier ;  the  lastj with  free sponging, in the later sta-
ges of the disease.  The choice may be left to the fancy of
individual patients.  After the use of the bath, the patient may
be scantily covered  until  reaction takes  place.  There is usu-
ally  no necessity for the employment of any collateral agen-
cies to  produce this effect, it being but the  result of a natural
law.   If deficient, however, external warmth,  frictions, etc..
may be applied in the usual way.  We will find, after the use
of the bath, arterial action and heat of surface notably dimin-
ished ;  a more equable  distribution of the circulation induced,
and,  consequently, determinations relieved ; free perspiration
breaks forth,  and the  patient falls into a sleep, from which  he
awakes  comparatively  comfortable.  Venoesection was form-
erly  constantly  here adopted:  we  should have recourse to it
with caution, as it may  be depriving the  patient  of strength
which, in the course of the disease, may be of the most vital
importance;  and bleeding has certainly not the effect  so fre-
quently  claimed for  it—the diminution in the proportionate
quantity of fibrin in the blood.  In addition to this, the depress-
ing  effects of heat and climate  materially interfere with the
reaction  usually anticipated.  The experience of this agent in
the East and South-East has, of late years, been particularly
unfavorable ; still, there are cases in which  we are  called upon
to adopt  it.   The " phlogistic diathesis," and the " sanguineous 
                             37

 temperament," frequently require it; the newly arrived stranger
 will bear it well.   The indications for the use of the lancet are
 thus given :  " the throbbing temple, red eye, turgid visage, full,
 hard, and abrupt pulse ; violent pain in the head and along the
 spine ;  hot,  dry  skin, etc."  When  called  upon to bleed, it
 should be from a  large orifice, with the patient  in the sitting
 posture.  Strong and dangerous determinations may thus  be
 speedily  controlled.   Topical  bleeding  has  been  frequently
 advised; and though this  practice, in these Fevers,  is much
 neglected, we should be disposed to frequently adopt it, as thus
 we have the beneficial effects of abstraction,  without  the  dan-
 ger.  We may frequently diminish arterial  action, and consti-
 tutional excitement, by the rigid withdrawal  of all  stimulus;
 forbidding noise or company; excluding light;  keeping the
 room cool, etc.
   Upon, cathartics, however, we principally rely in combating
 this disease.   These should be  given freely in the earlier; but
 only occasionally, and always cautiously, in  the  latter stages.
 It is  only as the case  progresses that  the  vitiated  secretions,
 poured into the gastric intestinal canal, may be regularly and
 efficiently  removed.   "Calomel is  the most  valuable of our
 purgatives; "  and though frequently and foolishly objected to,
 we should nevertheless look to it, as does the sailor to his sheet-
 anchor in the storm.   Though  frequently denied, this drug  is
 decidedly  sedative.  Beaumont, in his well  known case, has
 satisfactorily tested this fact; and Burnett tells us that, in the
 most violent cases of Fever scruple doses of calomel have  suc-
 ceeded  in arresting the nausea and vomiting.   In  this disease,
 then, where so much depends on the tranquil state of the stom-
 ach ;  and where medication is, at the same time, imperatively
 demanded, this drug offers us advantages  which we shall
 vainly seek to find in  any other.  Its  action is slow, and  will
 require, generally, some adjuvant.   The combinations for the
 fulfilment of this indication  are endless : Dr.  Rush's X and X
 is a  favorite formula.  With any of the resinous  cathartics  it
 will be found to combine and act  well.  Dr. Hunt speaks highly
of the combination here of  calomel  and  bi-carbonate  of soda:
Calomel, grs.iii or  v, with bi-carb.  sodae, 9i.   The action, he
tells us, is  mild, and occasions  nothing  of the  usual  griping. 
38
 Calomel is frequently given alone, followed  by sulphate mag-
 nesia?, ol. ricini, or an ordinary laxative enema.   It is commonly
 the practice to administer some sedative diaphoretic in the early
 stages of this disease; and though it has been argued that the
 actions of cathartics, and  diaphoretics,  are physiologically
 opposed to each other, still these views are, in  practice, disre-
 garded, and the old Latin aphorism, " vis unita fortior " acted
 upon.  As when looking  at the bow, in  the  sky,  we perceive
 one intermediate, produced by the blending of opposing colors,
 so may we thus expect,  by the happy  blending  of opposite
 agents, to  produce the modified action  of each.   Antimony,
 though objectionable as an emetic, is here frequently and bene-
 ficially used.  Any of its preparations may  be given, though
 the James' powder,  or tart, of antimony and potash are usu-
 ally  preferred :  the  pulis antimonialis  too  frequently  adul-
 terated,  and often inert,  can  not  be relied  on.  The differ-
 ent salts of potash will  all answer very well:  we  have  the
 nitrate, citrate, acetate, etc.  The spiritus mindereri is always
 prompt and pleasant in its action : the list of  sedative diaphor-
 etics will, at all times, afford us  the ability to offer an apposite
 prescription.
   When  cephalalgia is intense, counter irritation at the back of
 the neck, the cold affusion, or a bag of ice (a bladder most advi-
 sable) applied to the head, may be beneficially adopted.  Cold
 drinks come under the head  of diaphoretics, and may be freely
 allowed.   Remission comes on, and with it a  call for increased
 skill  and judgment.   We will  find, now, that  those remedies
 which occasioned nausea and vomiting, taken with  comparative
 ease ; if  the  contrary, however, this irritation of the stomach
 should be speedily allayed; as it is the extreme of impossibility,
otherwise, that the disease can be controlled. We have a number
 of remedies for this purpose: the old preparation  given us by
Paracelsus, paragoric, is sufficient in most instances, and gene-
rally fully adequate in any emergency; counter irritation upon
the epigastric region, by sinapisms, or stimulating cataplasms ;
brandy diluted, in small quantities ;  perhaps even a blister. Dr.
Thomas Inman speaks very highly of chloroform for this pur-
pose : three to ten drops in  a  glass of water.   Stimulants
applied to the nose ;  with the usual list of domestic remedies: 
39
Green mint applied to the epigastrium ; lime water and milk,
etc.  Some of these applications will usually subserve our pur-
pose ; and if not, our attention should be immediately given to
others—for this condition of the system is too pernicious in its
consequences, to be allowed long to exist.   All of our remedies
should be so timed  as to act most efficiently at  the period of
remission ; and our revulsives, for the controlling of determina-
tions, should be administered and  applied at the time of the
anticipated  invasion.  Cathartics  should be  given only  fre-
quently enough to keep the bowels open ; any thing beyond is
injurious.  If there be a constant tendency to constipation, fre-
quent sponging with, or the affusion of cold  water, will gener-
ally remove it.  The effect  of this agent may be explained on
the principle of "reflex action," as advocated  by Marshall Hall.
Mild laxatives, or an emollient enema, may be substituted, now
and then, for the  agents just mentioned.  One evacuation in
the twenty-four hours will be quite sufficient.   Our diaphoretics
should be gradually made more stimulating;  capsicum, carb.,
ammonias,  serpentaria, acetas  ammoniae, etc.,  may  be  now
used;  the carbonate of potash, with paregoric, is an  efficient
and favorite prescription.   Where there is coldness of surface
manifested,  resort  should  be had to steaming, epispastics, etc.
Objections have been made to this last agent, as increasing con-
stitutional irritation.  This, however, (if at all true) is entirely
disproportionate to the benefit produced.  Blisters are clearly
indicated where we have cerebral congestion, with tendency to
stupor, or somnolency ; to watchfulness and delirium, or lastly,
" where  and  when  similar effects  appear  to be  the result of
nervous  derangement."  Where we have cerebral congestion,
with the attendant train of symptoms, the blister is best applied
to the  back  of the neck ; when there is pain, distress, and unea-
siness of the stomach, with nausea or vomiting, the application
is of course  made over the  epigastric region.  In the last stages
of the disease blisters have been applied to the extremeties, to
rouse the vital energies, " as much, perhaps, in accordance with
custom, as  in the  hope of  their being of the  slightest advant-
age."  In the first and second instances they are  of undoubted
benefit;  but experience does not testify thus  when the applica-
tions are made to the extremities; they certainly cause here 
40
great prostration,  if allowed to vesicate ; 'tis well,  however,
observing this precaution, to continue  their use  even  here.
We should suppose,  as a general rule,  that  epispastics, in the
advanced stages, may be used as excitants during the parox-
ysm, and as revulsives during the remission.  A not unfrequent
effect of their continued  use, is  obstinate  and painful stran-
gury—both ischury and dysury.  Acton, in his treatise on this
subject,  has  recommended  an injection  of nitrate  of silver:
nitrate of silver, 3iv, distilled water, giv.   This,  he says,  is
uniformly successful in overcoming the temporary  stricture, or
rather, strangury.   The chief benefit,  however, of  a blister
here, is in controlling dangerous determinations, and preventing
nervous prostration.   After constant  nausea, generally head-
ache, watchfulness, and suffering, the patient passes through
another paroxysm, and  remission coming on, falls into a gentle
sleep, with, perhaps, free  perspiration.  If this  be  the  case, it
is quite favorable.  At other times, the remission may bring but
comparative easiness and rest, while the  cutaneous secretion
continues  obstinately suspended.   This symptom, in common
with the suspension of all important secretions, is, of  course,
dangerous proportionately with its duration.  Modern authorities
tell us to give here quinine as freely as it can be borne.   It not
unfrequently happens, however, that in every remission—in fact
until there is  apyrexia, that this  treatment cannot be  borne, on
account of the perpetual nausea and cephalalgia, etc.  Under
these circumstances the ferro cyannuret of iron would be bene-
ficial.  The patient, with these untoward symptoms,  will now
evince increased tenderness to pressure on the abdomen, and will
confine himself to the dorsal decubitus, so characteristic in this
condition of the case : when, with this, " there is a slipping down
to  the foot of the bed," so much dwelt upon, and so dangerous,
as betokening muscular debility and prostration, our  prognosis
will be gloomy.  Often, however, blisters, with topical bleeding,
counter  irritation, etc.,  will favorably and  rapidly change the
patient's condition, removing, at the same time, from  the  mind
of his physician, ominous forebodings of impending  and  anti-
cipated  evils.   If not done before, the administration of calo-
mel, for its specific effect, should now be promptly and energeti-
cally resorted  to.   Though we may, by the  revulsive, depura- 
41
 tive, and depletive effects of cathartics, with other valuable aux-
 iliaries, have considerably controlled the disease ;  still, if up to
 the present time, the patient's  condition  be not materially
 changed for the better,  nothing but the speedy, though judi-
 cious induction of ptyalism will warrant us in anticipating oth-
 er than a fatal issue.   With children, experience has taught us,
 that extreme caution should, in this practice, be used.  It is dif-
 ficult  to produce a  mercurial  action in  their systems;  and
 though we may occasionally induce a beneficial salivation, still
 these cases are the exceptions, and not the rule.  Most generally
 when this course is pursued with pertinacity, we have not pro-
 duced the beneficial and ectrotic action of the drug, but  have
 only succeeded in " mercuralizing " the  little patient;  and this
 is always attended with  the most distressing effects:  ulceration
 and sloughing of the gums and cheeks, with sometimes caries,
 or necrosis  in the alveolar processes  of the maxillary  bones.
 Unless in the most urgent cases, mercury in any form  had best
 not be prescribed in our practice with children.  Happily they,
 from not being subjected to exposure, are  seldom called  upon
 to undergo the chances and trials of this disease.   In these
 advanced and advancing stages of Bilious Remittent  Fever, our
 chances of failure, or success are intimately dependent upon the
 induction of a judicious ptyalism.  This treatment, so violently
 opposed, is, nevertheless, by those acquainted with  the,  at
 times,  terrible fatality of this  Fever, admitted as our mainstay
 in the times of danger.  Many have found  it inefficient, from
 having deferred its adoption until the virulence of the disease has
 rendered the constitution no longer amenable to the influences
 of mercury, or until the system has been too much  prostrated
 to rally. Salivation, per se, is of course  not in the least benefi-
 cial, but should be regarded favorably as the index of the gene-
 ral restoration of suspended secretions.  Calomel  should be
 given, not in accordance  with any  rule,  but until a gentle pty-
 alism is induced.  In some constitutions this is extremely diffi-
cult.  When such a  difficulty is presented, however, we may
generally succeed in removing it, by giving either large doses  of
calomel, closely restricted by opium, or grain doses every one or
two hours.   When  there is extreme irritation of the stomach,
this drug will  be readily absorbed by being held continuously 
42
  on the tongue.  Mercurial fumigation, as a last resort, may be
  instituted.  The nitro-muriatic bath of Scott, has been said to
  be successful, either  alone, or as an adjunct in inducing ptyal-
 (ism.   We would suggest  the cautious  administration of digi-
 ; talis, or  Dr. Norwood's preparation of the veratrum viride, for
 \ the production of  this effect; the diminution of volume, and
'• excitement in the circulation, we know, increases the action of
'  absorption : and as the action of our depletives has already
|  accomplished the  first indication, we  see not why,  by using
!  these medicines, for the accomplishment of the last, our principal
  object may not  be successfully effected.   It  is, of course, our
  duty to see that the effect of these drugs is not contra-indicated ;
!  and also that the patient does not suffer from the insidious and
  " cumulative " properties of these agents.  This practice would
  require,  imperatively, the extreme of caution ;  yet the  object, in
  our estimation, fully  warrants this  mode of its accomplishment.
  Although it has been said, " that our efforts will be more suc-
  cessful,  by the use of such  means as are better calculated to
  restore the secretions, than simply reducing arterial action ; " yet
  it must be borne in mind  that the readiest, and here the  most
  appropriate means of " restoring secretion,"  is by " reducing
  arterial action."  Colchicum, either alone, or combined with the
  iodide of potassium, enjoys now the highest reputation as a cho-
  lagogue ;  and Dr. Sturgeon, in his twelve very  valuable lec-
  tures on  galvanism,  states that a current of  electricity, passed
  through the right hypocondriac region, will succeed in restoring
  the biliary secretion,  when  all  other remedies  have failed.
  These agents may,  most undoubtedly, produce  this specific
  effect; still, it must  be  borne in  mind, that  the  suspension of
  the hepatic secretion, in common with that of all others, is but
  the effect of this disease, and not the cause ;  that, 'though this
  suspension may so modify its characteristics, as to give, in part,
  a name to the Fever, this condition of the  organ which sup-
  plies the hepatic secretion, often exists without inducing, in any
  degree,  the peculiar  symptoms now manifested.  Evidently,
  then, our only way of successfully restoring this secretion, is by
  removing the cause which thus manifests its effects—an  illus-
  tration of the oft inculcation : " Causa sublata tollitur effectus."
  The  ectrotic action  of  mercury, then—the substitution of an- 
43
 other morbid condition for the one existing—is our only means
 of fulfilling the  indication now presented, if a repeated and
judicious quininism fail.  Ptyalism  is, of course, a  serious
 evil; " but when two evils are forced upon  us, is it not nat-
 ural to choose the  least?". This peculiar effect of mercury,
 leads many to  proscribe it.  Yet blisters are, by these, freely
 used ; not seemingly  aware that the  sphacelation induced by
 this last agent, is far  more annoying, (dangerous?)  and tedi-
 ous of cure, than that  produced  by the first.   We should be on
 our guard, and quickly desist in the administration of mercury,
 when its peculiar effects are observed.  The prompt ameliora-
 tion in the symptoms and condition of the patient will be man-
 ifested to the  most  superficial  examiner:  The moist tongue;
 freedom from thirst;  soft skin; diminished sensibility of the
 eyes  to  light; free  perspiration; and  lastly,  " tired  Nature's
 sweet restorer, balmy sleep." The marked tendency to relapse,
 lastly, is notoriously diminished by ptyalism.  M. Melsens, in
 a recent and interesting paper, has suggested the administration
 of the iodide of potassium, in dangerous salivation.  He states
 that the metallic poison  is " in actual union with the affected
 parts, and retained there in an insoluble form.   *  *  *   That
 the iodide of potassium, after its absorption into the blood, com-
 bines with the metallic poison, and forms with it a soluble salt.
 *  #  #  #  That ^5  new compound, set at liberty in the form
 of the double  iodide of mercury and potassium, is eliminated
 by the kidneys.   *  *   *  * "   There are  many common and
 domestic palliatives—watery solution of opium, the chlorides,
 borax, charcoal,  etc.  Throughout this disease—even  in  the
 protracted  forms—we should  always  see that  the  patient
 receives a sufficient  amount of  nourishment.   This compara-
tively minor piece of treatment,  with the constant inspection of
the alvine evacuations, is strictly our  duty.   It is not unfre-
quently the case, that  after a patient has been confined for a
few days, with an attack of this Fever, in the  country, that he
is brought to the city; and this piece  of imprudence is often
fatal.   The known  tendency of  city atmospheres to increase
the virulence of a pestilential  Fever, should  prevent such a
course.  The mild epidemic, which, in the country, causes no
alarm, and yields readily to treatment, when developed in a city 
\\
 not uncommonly becomes "the pestilence  which  walketh in
 darkness and destroyeth at noon-day."  This effect of a city
 atmosphere has been denied, on the ground that  Fevers of this
 kind are not  so fatal as those out of it.   This may be, and in
 true, but from the obvious reason, that the materies morbi is not
 so prevalent,  or concentrated in a city ;  and this is  proved by
 the very small quantity of our anti-periodic agent which is
 required for the removal of such Fevers there.   A cold atmos-
 phere cannot produce an eruptive Fever; but when such exists,
 it is alone sufficient to make it fatal.  In the last stages of this
 disease—when our treatment has so far been unsuccessful, the
 safety of the patient depends upon  an active and rigid adher-
 ence to  the mercurial treatment—we should now accelerate the
 production of ptyalism by all the means known to the profes-
 sion.    As a  dernier resort,  all blistered surfaces should be
 sprinkled with calomel; and frictions with mercurial ointment
 promptly instituted.  The endermic method  will often  promote
 our object here; but should be adopted only in desperate condi-
 tions, and then with the utmost caution and care,  as  its unfortu-
 nate and disasterous consequences are not unfrequently mani-
 fested.   At the same time that this  practice is  instituted, the
 strength and  vitality of the patient should be supported by con-
 stant stimulation,  with regularly  administered   nourishment.
 Where  stimulus is immediately demanded, the alcoholic, as
 being most prompt, should be selected in preference to the vinous
 liquors ; but  when there is time afforded us,  the last should be
 given, as the duration  of their effect is  more gradual and per-
 manent.   The dyspnoea, which most probably now increases,
 may be  relieved, it  is  suggested, by diminishing the demand
 for air; and, for the  fulfilment of  this indication,  chloroform
 would, of course, head  the list.   The bowels may now become
 loose ; and if this be the case,  a fatal,  rapid, and colliquative
diarrhoea may be  anticipated.   This can seldom be relieved,
dependent  as  it often  is,  upon the ominous  relaxation of the
sphincter.   The discharges often now exhibit a pinkish hue,
 which speaks of inward mortification, and are of the  most offen-
sive character.  This condition  lasts but a short time;  prostra-
tion rapidly ensues; the patient quickly sinks;  and the  final
scene takes place.  This is usually  the course of an uncompli- 
45
rated and fatal case of Bilious Remittent Fever.  Most gene-
rally, however, successful quininism or ptyalism can be in time
induced, and the patient advances through a  slow and tedious
convalescence to eventual health.
  The " Congestive " and " Typhoid " forms of this Fever not
unfrequently present themselves ;  but it is not  necessary to go
in detail, through the treatment recommended for each of these.
By the symptoms  given, they are readily recognized; and we
have only to treat these cases on general principles.  The " Con-
gestive " requires heroic stimulation and prompt ptyalism. With
the Malignant, another form yet, we have to observe still greater
caution and care, recollecting that, as its name imports, it is the
most dangerous manifestation of this Fever with which we have
to deal;  while, lastly, in the " Typhoid "  variety  we have  to
institute very nearly the identical course of treatment, advised
in the fever which is designated  by this name.   When a favour-
able change occurs, we adopt the  same practice advised in the
apyrexia of an Intermittent.  If, on the contrary, we are to an-
ticipate a fatal issue, it is our duty to remain with our patient
to the  end :  " never disheartened by the apparent inefficacy  or
slowness of impression ;  to persevere, not only while there is a
reasonable  hope, but even after all  hope seems extinguished.
Thus, though disappointment be frequent,  we may " be repaid
by the gratification, which will not be denied us, of saving more
than one fellow-creature from the  destruction which seems  so
inevitably to await him."
   We cannot leave this part of our subject, without alluding to
the  endosmotic and exosmotic  action of medicines which now
deservedly attracts so much attention.   Many  have attempted
to prove that the  effect of all  cathartics may,  in  this way, be
explained.   Full experiments have been  instituted, however,
both in Europe  and the United States;  and though the action
of these laws is frequently manifested, still  it  has been fully
proved that their effect is not uncommonly "overridden" by that
peculiar and prophylactic agent which we recognize, as the vital
principle.  Dr. Cogswell, in an interesting paper  read  before
the London Medical  Society, after impartially  criticising the
experiments and deductions of Dutrochet,  Poisenille, Bachetti,
and  others, observes, " that the division of substances into those 
46
 favourable to endosmose and  those not,  * *  *  requires confir-
 mation ; that the power of endosmose, of different solutions, is
 not regulated entirely by their density, as observed by Dutro-
 chet."  Lankester, Bird,  Snow  and Chippendale have, in effect,
 endorsed  these opinions, and state the results of experiments
 in support of their opinions.  This wide field is therefore com-
 paratively unexplored, and the so-styled facts should be received
 with caution and allowance.
   Diagnosis.—The diagnosis  of an Intermittent is at all times,
 and to every one,  easy.  A single paroxysm will declare the
 nature  of the disease.   In  Bilious Remittent, though  not so
 simple, we could  scarcely make a mistake.  In the country we
 can  scarcely confound this disease  with any other.   Season and
 locality would seem to distinguish  it from  Typhus, or Typhoid,
 (for  there  is no real difference  between them, though  authors
 make a distinction, and  it is still thought to be a  question of
 degree, simply,)  for which it has  been mistaken.  In the city,
 however, Remittent Fever is frequently confounded with Yellow
 Fever.  Accurate examination and observation, we should sup-
 pose, would correct such a mistake.  In Remittent Fever, we
 have an indefinite number of paroxysms, each paroxysm of two
 stages, the pyrectic and the semi-pyrectic,  generally continuing
 through several of these  paroxysms: great want of uniformity
 in its course; sometimes  continuing a pure synocha, sometimes
 becoming  typhus, sometimes,  again,  congestive, and  where
 this  congestion does  take place,  resembling  that  of Yellow
 Fever no  more than congestion  in any other kind of  Fever.
 The effect of this Fever  is the  production of an increased lia-
 bility to future attacks, though,  happily, their virulence is  thus
 mitigated.  It is not in the least contagious: attacks, invariably,
 in the day, and chiefly the  most  exposed  adults.   In Yellow
 Fever, we have only one paroxysm, and this rule is invariable.
Each paroxysm  is divided into three stadia:  the pyrectic, the
complete intermission, the congestive, or  state of collapse ;  which
last uniformly succeeds the  second stadium.   When  the par-
oxysm is completed, unless there be relapse, we have no  return
of it.  The disease consists, essentially, of one paroxysm, and
 its effect produces a  notorious exemption  from future attacks,
 unless the patient be exposed to the causes of it, in a latitude 
47
South of that in which the original attack was induced.   Lastly,
Yellow Fever attacks, invariably, at night, chiefly the younger
portion of native residents, and is one of the very types of con-
tagion.   With these contrasted symptoms, one should not expe-
rience  much difficulty in making a clear and correct diagnosis.
As coming under the head of Diagnosis, it has recently  been
suggested that the  comparative degree of acidity or alkalinity
existing in the gastro-intestinal canal,  may be indicated  by
means  of  test  paper applied to the  tongue.  This seems but
reasonable, and would,  beyond doubt, subserve a valuable pur-
pose in the treatment of disease.   If the facts  relative to this
object  were carefully collated, we  should often be enabled  to
solve another wise, intricate, and complex problem—Prognosis.
Hippocrates tells  us, "that the best phvsician seems  to be, he
who knows how to know  in advance ;"  and  the testimony  of
ages has since proved as well the verity as the sagacity of this
remark.  The advice of the father of medicine on this impor-
tant subject, will never lose  its value: " Examine,"  says he,
the countenance of the patient, to see if the physiognomy is
like that of a person in health, and  especially if it preserve its
natural expression.  This is its most favourable state, and the
more it departs  from it,  the greater is  the danger."  In In-
termittents, our prognosis, is  very favorable : in vernal  most,
in autermnal least so.   In Remittent  as in Intermittent Fever,
severity of attack is no  indication of the severity of the dis-
ease.   The cold stage  of  an  Intermittent is dangerous in pro-
portion to  its duration; the  hot stage  to its intensity.  In the
cold stage we may have positive, or negative death : in the
first, from  the  carbonized  state of the blood,  and  in  the  last,
from the non-fulfilment of function  by the cutaneous appara-
tus.   In the Remittent Fever, individual prognosis depends
upon the  previous  history of the patient: his habits, degree
of exposure, yielding, or resiliency of constitution, force of mind
and character (for the contrary produces an unfavorable impres-
sion, dejection, and, in time, prostration,) constitution of air, ame-
nability of system to the action of our medicines, irritation and
tolerance of stomach, extreme  frequency of pulse, (more than
140 beats in the minute being extremely unfavourable,) dryness
and blackness of  tongue, etc.   All obstinate determinations are 
48
unfavourable :  restlessness, pervigilium, jactitation, the propor-
tionate suspension  of function in any important organ, com-
plaints of heat when the surface is  cold, dorsal  decubitus, or,
perhaps,  orthopnoea, (this is most observed in those forms of this
Fever marked by  thoracic congestion,) change in expression
of countenance, with bronzed surface, syncope,  insensibility to
light, noise, surrounding friends,  or objects,  etc.  This long
catalogue contains  the  unfavourable symptoms  manifested  in
any, or all of these forms of Fever.   Of course, the contrary, or
absence of these symptoms, is in favour of the patient.
  We see, thus, that there are many  circumstances which must
affect our individual prognosis.  General prognosis is, on the
whole, favorable; one in  forty being put down as  the propor-
tionate mortality of this Fever.  This mortality is, of course,
among the labouring class, and from obvious reasons.
  We proceed, next, to consider the causes of these two dis-
eases ; and as those offered, with the  relative arguments, are in
themselves sufficient material for  a  lengthened discourse, we
will confine ourselves to a but  comparative enumeration,  and
pass  by this branch of the subject  as briefly as possible.   The
predisposing causes are  many: race,  rapid alternations of tem-
perature, labour and rest, degree of acclimation, and the vitia-
tion  of this  by incautious and  constant change of residence
during our summer months;  a winter spent North of resident
latitude,  dissipation, fatigue,  anxiety,  poverty of diet,  hygro-
metric state of the atmosphere rapidly changing, "the existence
of susceptibility to zymotic diseases,"  etc.   This last instance
of predisposing cause is now attracting  much and interesting
attention. Dr. Carpenter's views are  sufficiently forcible and
plausible.  The great and chief cause, however, of these Fevers
is  that agent of which,  after so many discussions, theories and
speculations, we know but little.  The subtle poison of malaria
we can, as yet, recognize only by its effects;  its cause,  nature
and essence, being yet wrapt in the mists of a vague hypothesis;
the toxic apocrypha, the  mysterious hieroglyphic which, tran-
scribed by nature's hand, owns not yet its Champollion.
  After all the theories (since controverted) offered by McCul-
lough, Ferguson,  Dwight, Mitchell, and a host  of others,  we can
find no better  description of this agent,  than  that incidentally 
49
given by " a bright particular star " in the literary firmament of
England: " Malaria  settles not over  thin and  barren soils, nor
over wastes  that have been from all times desolate, but over the
places in which Southern suns  had once ripened delightful
gardens, or the sites of cities in which the pomp of palaces has
passed away." The absence of diffusibility (spontaneous) proves)
this agent to be non-gaseous in nature; and the futile analysis
of most of the gases manufactured in Nature's laboratory, would
tend to corroborate this view.   From the past and present ina-
bility to detect the element which is  recognized by this name,
and also the failure to demonstrate any  poisonous principle in
the atmosphere peculiar to its habitations,  we would hazard the
suggestion, that the effect produced by this supposed agent may
be but  the catalytic  action of an innocuous component of our
atmosphere, finding entrance into the .system by cutaneous endos-
mosis.  This may explain how the comparative obstruction of
this action in the skin of the  negro race produces exemption
from this form of disease.
  We have not space  left wherein to state any reasons in sup-
port of this assumption of catalytic action; but  Chemistry and
Nature both afford us instances of the surprising results of cata-
lytic force.   We come now to the  most interesting part of our
subject: to that agent which we sincerely believe is yet to occupy
one of the brightest pages in medical history.

                          OZONE.

  We will first state the most important/acte which, in regard
to this agent we have been able to collect and collate  from the
most authentic sources,  and  then offer a few of the most rea-
sonable suggestions  that seem to flow therefrom.   M. Schon-
bein, of Basle,  who  first chiefly called public attention to the
subject of Ozone, regards it as  " an independent body and consti-
tuent of the atmosphere " uniformly present,  though in varying
quantities.  Faraday who has  thoroughly and  closely investi-
gated this subject,  and  whose  cautiously given  opinions are
entitled to the highest respect and deference, differs in a few
unimportant  particulars from Schonbein, but nevertheless sup-
ports him entirely in all  of those views which are of the most
           4 
50
practical importance.  Schonbein regards Ozone as a binoxide
of hydrogen, H. O3;  but as this equivalent  is not always uni-
form, he prefers to style  it a peroxyde of hydrogen.  Ozone is
generated by the passage of electric currents through the atmos-
phere, or rather by the discharge occasioned  by the meeting  of
currents charged, as in  the form of clouds, with different elec-
tricities ; " by electric combustion, and when the electric spark is
discharged from the points of a conductor ; by  the oxidation of
phosphorus, partly in water, partly out of water, placed in large
bottles with  close stopples.  Vapour is thus soon  formed ;  and
by washing  the gas,  which is insoluble,  we remove phosphorus
acid with the vapour of phosphorus, these last being soluble,
and Ozone remains behind ; by passing  a current of electricity
across the surface of  water in a  vessel, etc.  Plants, not excited
by light, act upon the atmosphere and produce this body.   This
gas, when concentrated,  manifests  an odour similar to that of
chlorine;  but when  mixed with atmospheric air, the odour is
" similar to that emitted from an electric machine  when in mo-
tion."   It is, in its effects,  extremely injurious to the organs of
respiration.   Mice perished in an atmosphere only l-6000th part
of Ozone.  This agent is  insoluble in water; destroys organic
colouring  matters, as well  as  those having  albumen, or lignin
for  their base.   It has the greatest affinity for oxygen of any
substance known; quantity prevailing in the atmosphere great-
est in winter, least in summer; purifies noxious exhalations,
though  exhibited  in the  minutest quantity;  destroys both idio
and koino miasmata, and is able to purify 540 limes its volume
of inquinated air; hydrogen with selenium,  sulphur and phos-
phorus,  all in the minutest quantity in the atmosphere, yet render
it unfit for respiration ; and Ozone, from analogy, supposed  to
belong to the same class.   It is the most rapid oxidizer known ;
rapidly  destroys hydrogenous compounds, a constant source of
miasm liberated in gaseous forms, by the  decomposition of vege-
table matter, etc.  The true nature of these gaseous compounds
is not known;  but here it is sufficient  to know,  that if these
gases were allowed to remain long in the  atmosphere, this would
be rendered  unfit for respiration.  Malaria may be either a me-
chanical,  or chemical compound of two,  or more of these gases;
yet forming by this  combination not a gas,  or  a compound 
51
gaseous  in nature;  we  have  water formed by oxygen  and
hydrogen.
   Faraday regards Ozone as an allotropic condition of oxygen,
but admits it to be present when  oxygen is present,  or where
and  when water exists in a vaporiform condition.
   The purifying properties of Ozone are proved by the fact  that
no deleterious substance has ever been separated from an atmos-
phere containing it in excess.  Ozone rapidly diffuses itself in
the  air;  is decomposed  by heat; is manifested  in  increased
quantity in the morning ;  forms an oxyde with, or is capable of
oxidizing nitrogen ; gives to the  atmosphere peculiar chemical
properties; bleaching effect of the sun's light attributed to it;  pro-
duced by the chemical agencies of electricity and magnetism.
Schonbein mentions, that in testing the atmosphere contained
in a bottle half filled with  turpentine  (oil)  which  had been
exposed to sunlight and air,  Ozone was manifested.
   The decay, diseases and  deaths of animals and plants destroy
Ozone; the ammoniacal and sulphur gases of the atmosphere
are  oxidized by it, forming, thus, acids and salts : when in
excess in the atmosphere,  pulmonary diseases are rife.   The
method of forming the test paper for detecting  its presence is
thus given: " Iodide  of potassium gr. i,  starch grs. x, distilled
water  grs. cc;  immerse a piece of bilulous paper in this solu-
tion, and  then dry it for use: when taken out, there will  be no
change until dampened with water.  Iodine must be in its free
state, to give the blue test with  a cold solution of starch.  This
is usually accomplished by a  few drops of an acid,  or a little
chlorine water.  In the test paper experiment, Ozone plays the
part of this acid, or  chlorine water; it  disengages the iodine
from the  potassium, and uniting with the potassium,  forms po-
tassa, while the iodine unites  with  the starch, and  forms the
blue iodide of fecula.  The depth of this blue will depend, of
course, upon the quantity of iodine  set at  liberty, or in  other
words upon the quantity of Ozone present.   The air coming
from the sea gives a deep blue  color; that passing over a city,
scarcely any.  The current of  air from a partly closed door, or
window, will give a marked  hue to the test paper.
   We have given, thus, without preparation, or classification
the result of our examinations  into the best authorities on this 
52
subject: these authorities we have found surprisingly few, and
we believe that we have consulted most of those at present acces-
sible.  We proceed now  to consider the relations of Ozone  to
disease.
  The prevalence  of  this  principle in the  atmosphere, and
the prevalence of certain  diseases,  have  been lately  said  to
be relative ;  that the greater the quantity of one, the greater the
malignity of the other, and conversely : thus the prevalence  of
pulmonary  diseases and Ozone are in a direct ratio, whilst the
prevalence of Ozone and the malignity of malarious fevers are
in an indirect ratio.  This view has been assailed, on the ground
that  the generation  of  Ozone is not sufficient  for  it to  become
one  of the  controllers of  disease;  that on however large  a
scale it may be formed during the electrical commotions of the
atmosphere, these do not occur sufficiently often to furnish this
principle in  quantities  at all proportionate  to the fulfilment  of
the object claimed.  Again it is objected,  that  Ozone is  most
abundant in winter; at a time when electrical disturbances are
notoriously  infrequent.  Its  being generated  by the action  of
"plants not excited by light," is claimed to be not well estab-
lished, and even if so, that this supply would be but a small
fraction of the amount  necessary ;  its preparation by the oxida-
tion  of  phosphorus under  peculiar circumstances  (from this
being an artificial and complex process) is not at all regarded
in the discussion.  So far,  we must confess that the objections
to the views proposed are plausible and just; but we cannot lose
sight of one of the facts stated, in our desultory enumeration  of
the experiments,  viz:  that the passage of electricity  across the
surface of water in a vessel,  was found to generate this agent
with great  facility.  This,  to us, seems one of the most impor-
tant facts ever disclosed to the profession.   What gives polarity
to the electric needle, but those vast belts of electricity constantly
moving and encircling our globe; and though  the  magnetic
equator is constantly changing, its  existence is as clearly de-
monstrable as the most elementary  of philosophy's laws.  To
falsify this,  would be  to  pluck the well merited chaplet  from
the brows of some of the most noble of those who have achieved
distinction in the fields of Science.  Barlow, Brewster, Becquerel,
and others, toiling here,  have  rendered their  names immortal. 
53
This fact  is beyond dispute, and who shall undertake to assert
that one of the objects of this subtle fluid, in its circle, is not by
its action on the vast expanse of water which it spans, to elabo-
rate an agent, bringing purity to an atmosphere which, other-  j
wise,  would soon  contain within itself the  seeds of a general  i
and inevitable death.   We cannot  but think this entirely true ;
and examine as we may, there  are facts which seem sufficient  :
to support the suggestion  in  its minutest particular.  Let  us
compare the general existence of Ozone with  some of these
 facts given.  We find it to be the most rapid oxidizer known ;
that it is capable of exerting this action on all of those noisome
gases and vapours which poison our atmosphere ; that it is de-
composed by heat; and that its excess is in winter.   Is not the
 deduction plain?   Ozone, it is  reasonable  to suppose, is formed
 nearly equally at all seasons of the year:  when and where pesti-
 lential vapors, or gases, are greatest, is it not  most largely con-
 sumed ?  These exhalations are,  of course, greatest in summer; and
 at this time we have high solar  heat, the one consuming by oxi-
 dation, the other by decomposition, is it not a necessary conse-
 quence that Ozone should be found " least" at this season of the
 year, and most in winter, when the causes of its consumption are
 in  abeyance ?   Is there no reason why alluvial soils should  be
 most unhealthy,  as, from the gases and vapours which they
 evolve, consuming (with heat)  the agent, given for the purifica-
 tion of the atmosphere around  them?  Can we not thus under-
 stand why epidemics have prevailed in regions before unvisited
 by them ?  Thus, " Chemical  agencies produce Ozone ; decay,
 disease and death of animals and plants consume it."  Imagine
 this balance still preserved, but with increased solar heat, and is
 not disease developed?   Again, have solar heat no higher than
 usual, but the balance between the production and consump-
 tion of Ozone destroyed, will there not be disease?   Lastly, as
 in the tropics, have intense solar heat, with the extreme of vege-
 table  and animal  decomposition producing  mephidic exhala-
 tions,  and must there not  be those malignant forms of disease
 developed which  so characterize those regions of the globe?
 Fortunately in that meridian,  from  the coincidence of the elec-
 tric circle, there  is reason to  believe  that this agent is  most
 abundantly  formed; but again,  the least disturbance in  the 
54
   balance, from the causes there at work, must give rise to the
   fatal forms of Fever peculiar to such latitudes.  These remark-
   able properties of this agent explain to us the cause of the marked
   mitigation of symptoms, so  manifested in our  Fevers on the
   supervention of a summer's storm, and  its highly oxidizing pro-
  I perties may serve to make intelligible the existence of malarious
,  ; Fevers in ferruginous localities,  as in  India, etc.  In the one,
   the mephitic vapours and gases of the  atmosphere are neutral-
   ized by the increased accession of Ozone; and in the  other, this
   agent is  consumed by its extreme  affinity  for all  oxidizable
  \ bodies.  Ozone, from the absence of heat and decreased exha-
  ■ lation which, as we have said, respectively decompose and con-
   sume it, is most abundant in the morning;  it forms an oxide
   with nitrogen, most probably the protoxide, and hence the ex-
   hilarating effect  of the air at this period of the day?   By the
   test paper, we find the air from the sea  containing an excess of
   Ozone.  The reason of this is obvious and  twofold, as here the
   agent is most largely formed and least consumed.  The cheer-
   ing and life-giving effect of sea air was known  and advised by
   the earliest writers of the profession, who, ignorant of the cause,
   yet profited  by the effect.  Is not the cause such as we have
   suggested, the absence of the materies morbi with the exhilara-
   tiug combination of oxygen  with nitrogen ?  Chemically ex-
   plained,  the  combination of one atom  of Ozone with two of
   nitrogen, hydrogen being given off, would give us the protoxide
   of nitrogen.  This can not be too hypothetical; for Faraday, the
   highest authority, tells us that Ozone is capable, in the  atmos- '
   phere, of  existing in an allotropic state.
     " Ozone in excess is prone  to the production of pulmonic dis-
   orders."   It is a recognized fact, that Eastern winds in America
   and Westerly winds in Europe, as coming immediately over the
   sea, have been usually attended and marked by this peculiar
   effect.  Travellers in Africa tell us, that pleurisies, pneumonias,
   etc.,  mark the coincident occurrence of certain winds, and that
   the natives suffer almost exclusively.   This naturally leads us
   to the deduction of falsity in that theory which advocates the
   pulmonary inception of malaria.  Negroes,  we  know, suffer
   soonest and  most (the remark  above would  substantiate this)
   from pulmonary affections, shewing thus their  increased sus-

 xjLzaa.4' iM^A-^iy trL CiiX   1s^3 0V4 e^^t^Xtny   Bjp 
55
ceptibility to the action of those agents which interfere with the
healthy condition  of these organs.   If the doctrine of the pul-
monary inception  of malaria be true, then this race should be
the most susceptible ; but  facts notoriously prove the contrary.
We are forced to make a reasonable deduction from  the fact of
Ozone being found,  by test, in the  atmosphere contained in "a
bottle partly filled with turpentine,  and exposed to the action of
light and air."
   It has long  been supposed that  the pines of our Southern
country  "exerted a chemical effect" upon the poison of malaria.
This, for a long time vague, conjecture now finds, thus, an in-
teresting corroboration.  What more probable, than that Nature I
should, in  the magnitude and magnificence of her laboratory, j
produce  the same principle that we, in  our  miniature efforts,
have boasted to originate;  or what better  calculated to impress
us with the happiest conceptions of Omniscience, than that these
stupendous  agents,  which produce it,  should be placed just
where this  purifying element is most needed and  consumed!
On reference to Chemistry, we  find the turpentine to be C5, H4,
and with this, the  now interesting remark, " Bottles in which
rectified turpentine, not purposely rendered anhydrous, has been •
preserved, are often studded in the interior with groups of beau-
tiful,  colourless, prysmatic crystals,  which form spontaneously;
these crystals contain C20, H16, H6, O6," or  four parts of turpen-
tine,  with the incidental H6, O6 added.  It needs but a glance
to see that we have here the elements of Ozone, though not in
correct proportions ;  but we  must again recollect Faraday's re-
mark, that Ozone is only an allotropic condition of oxygen •
" no change of matter, but change of stated  He instances this
by phosphorus : heated up to 464° Fah., its composition remains
the same, but its properties are en.irely changed; it now  re-
quires a  high temperature for combustion, but submitted again
to a low  red  heat,  it  returns to  its original state.  Thus  then   i
any cause (further exposure or chemical reaction) may change
the relative proportion, or  state of  this new compound, thus/
forming Ozone, whilst its actual composition, in elements,  re-
mains the same.
   Be  this explanation correct, or not, the  fact of Ozone being
thus formed  is undoubted.   The balmy  influences of our so- 
56
 called terebinthinate atmospheres  here find a reasonable and
 plausible explanation.
   Lastly, we see that the dangerous accumulation of miasm is
 prevented by  Ozone, whilst, conversely, the pernicious concen-
 tration  of Ozone  is  corrected and controlled by miasm;  that
 miasm is chiefly the cause of malarious fevers, and hence that
 any agent, capable of destroying it, bears by its proportionate
 presence and action, the closest "relation " to the existence and
 malignity of  such fevers;  that where it is in excess, fevers of
 this type are comparatively unknown, and where we have en-
 tirely the reverse, these  fevers are malignant and often fatal.
   Much more might be said on this interesting subject,  but we
 have already  far transgressed our limits, though we hope there
 has been shewn an intimate relation between the  relative exist-
 ence of  this agent and that of  those fevers which form a part of
 our dissertation.  We can not but  think that the variations of
 the magnetic  meridian, as shewn by the relative  dip  of the
 needle,  would, if  compared with  the  existence  of malarious
 fevers in various localities, and at various seasons,  lead to the
 most interesting and important results ;  or, again, if the relative
 hue of the test paper be compared with the prevalence of vari-
 ous diseases, that a flood of light would be shed on the obscu-
 rity of this highly interesting and important agent.
   The comparative presence or absence of Ozone having been
thus considered, with the " causes " of malarious fevers, we now
 leave it in connection  with this part of  our subject, and proceed
 to bring this essay rapidly to a close.
   The effects of these fevers are extremely various and compli-
 cated—Anasarca, icterus, chronic hepatitis, chlorosis, etc.—but
 the most uniform is the enlargement of the spleen.  Dr. Ramsay,
 of this State, has given  an account  of  an autopsy, in  which is
 mentioned the most extreme enlargement, we believe, on record:
 the spleen  in this case weighed  30 pounds.  An instance in
 which the spleen is said to have weighed 32 pounds has been
 recently mentioned; but we can not say if this case is as authentic
 as  the one just given.  We have now and  then a  harmless
 haematemesis  occurring,  the stomach reciprocating, as it were,
 the vicarious action of the spleen.   The anaemic condition, in
 which the patient is left, furnishes abundant room for specula- 
57
 tion  and investigation.   The fact, that the red corpuscles are
 always least in the splenic vein, is here not  without interest;
 passing as  they  have  just  done,  through a  ductless gland,
 and  manifesting a  notable  deficiency, it  is  not  improbable
 that  while  in this organ,  such changes may have been im-
 pressed upon them,  as to  develop by an altered constituency
 an elective  affinity  for  other glands,  by which, after  having
 subserved their  destiny, or object, in the  economy, they are
 eliminated from the circulation, and, suspended in  some secre-
 tion, finally cast  off.   If this can be the function of the spleen,
 in its  normal state, or when  a certain  quantity  of blood is
 received  into it,  why not suppose  that  when the organ be-
 comes enlarged,  and the quantity contained  greater, that the
 elimination should be abnormally increased.   Certain it is that
 an enlarged spleen and a marked deficiency of the red  corpus-
 cles are coincident.  Physiology teaches us,  that the quantity
 (proportionate) of red corpuscles in the blood,  and the  position
 of the animal in the scale are relative.   By the views most re-
 cently advocated, these  corpuscles  are  considered as oxygen
 carriers; and as we descend in the scale we find, coincident with
 their deficiency, a great impairment  in the function of  calorifi-
 cation ; in the cold-blooded animals they are  almost  entirely
 wanting.   By relative analysis of  fibrine, red corpuscles, and
 muscles we  find from the similarity of composition manifested
 in the second and last, that the old theory which advocated the
 genesis of the last,  by the first, false,  and that the last must
 be produced  by the second.  In  addition to this similarity in the
 composition of the red corpuscles and the muscles, we find that
 the activity of muscular fibre is dependent upon the relative
proportion of the corpuscles.  Low in the animal scale, we find
 torpidity and the entire absence of these corpuscles  coincident.
 Knowing,  thus, that these corpuscles  are least in the  splenic
vein,  (shewing their alteration in structure, or their diminished
quantity being caused by their circulation through this organ,)
and again the marked peculiarities which characterize their de-
ficiency, (atonic condition of muscle and decreased calorifica-
cation,) it seems  but reasonable  to infer, that not only is the
function of the spleen that of altering or eliminating these cor-
puscles, but that when this organ becomes enlarged, this func- 
58
 tion is abnormally increased.  We speak of this elimination  as
 before, being only to impress such elective affinities upon a cor-
 puscle, either in alteration of chemical composition, or material
 form, as to fit for elimination by secretion.   These corpuscles,
 we  are led to suppose, are intended for the constant genesis of
 muscular  fibre, and as vehicles of caloric;  but when dimin-
 ished exercise and temperature diminish the necessity for this
 their consiunption, it  can not be  unreasonable to suppose that
 their normal proportion may be regulated by the spleen ; and
 that this, when diseased or enlarged,  may exaggerate the natu-
 ral function,  and originate  an  abnormal constitutional condi-
 tion—debility and diminution in the process of calorification.
 It can all, however,  in our  ignorance as to  the physiology of
 this organ, be but an  empty speculation, based upon a false
 hypothesis.
   The necrotomy of these diseases affords nothing either  satis-
 factory or definite ; the brain  rarely, if ever, presents any lesion,
 though the meninges are not  Unfrequently injected ; the spleen
 is either hypertrophied, or indurated, or  again soft and  disinte-
 grated, being  a mere mass of grumous blood; the stomach  is
 injected; and where the disease had passed into the typhoid form.
 there is necraemia with  the ulceration of the  glands of Peyer;
 the liver presents a peculiar appearance, indurated, and in  color
 a mixture of " grey and olive."  On the whole, this part of our
 practice has not yet aided us in the treatment of these diseases.
 It has been the boast of the Scalpel that it can, unaided, illumine
 the obscurity which enshrouds the mystery of an unintelligible
 death ; but unless the  previous history of the case be known,
 with  the  symptoms  throughout  its course, " studium  cum
 calamo " instituted, and this carefully compared with the mani-
festations after death, we  can expect here but little from this
 branch of our science.  He  who, with the knife alone, would
assert the  ability  to designate the past disease,  makes but an
empty boast; 'tis  the absurd boast  of him  who alone gazing at
the blasted and riven trunk,  would declare to us the events of
the storm which had destroyed the tree.
  In convalescence from these fevers there is a marked tendency
to relapse, and the patient progresses slowly and tediously to a
perfect restoration of health.   Our attention and  medicines at 
59
this time will  materially benefit him, and accelerate recovery.
The investigations of Becquerel, Kodier, and others, on Haema-
tology, shew that in those who have been the subjects of " marsh
cachexy" or malarious fevers, constantly repeated, "the water
of the blood is proportionately increased, and the red globules
absolutely diminished," and here our remedies should fulfil this
indication—quinine, or what is still better, cinchona, combined
with the different  oxides and salts of iron, manganese and iron,
etc.;  for  the liberal  supply of oxygen, manganese and  iron,
manganate and chlorate of potash, etc.   At the same time, from
its  peculiar and specific action on the muscular fibre, we had
best administer some of the salts of strychnia; the acetate given
in the ^ of a grain  three or four times a day, is a favorite
prescription.  The patient's diet should be mild and nutritious;
exercise gradual and increasing; ale, from its gently stimula-
ting, anodyne, and nutritious properties, should be freely given;
change of air,  pleasant company, sea bathing,  etc.:  with these
adjuncts,  we may predict a permanent and speedy recovery.
  These repeated succussions tend to gradually undermine the
constitution, and the mortality of our alluvial districts is known
to all.  Visit the populous graveyards of our lower country, and
observe how seldom has  he whose melancholy office it is " to
memorialize our dust" been called upon to declare to posterity
that the representative of that  future mystery which now ten-
ants the spot ever  lived to find  his years but " labor and toil."
If this be the euthanasia so much coveted by Caesar, then should
the residents of these  localities be unhappy indeed ; but when
called upon to drop the tear of sympathy and compassion upon
the tottering gait  of the decrepid septegenarian, should they.
living thus in the garden spot of their country, not find comfort
in the  reflection, that though unpermitted to be actors  in  "the
last scene of all which closes this eventful history," they may-
yet  bear their part in those which make not the past oblivion,
the  present inanity,  and  the  future an  unconsciously   still
nearer mystery? 
4