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LECTURES
YELLOW  FEVEE,
CAUSES, PATHOLOGY & TREATMENT,
JOHN HASTINGS, M. D.,
  UNITED STATES NAVY.

r£~
    PHILADELPHIA:
LINDSAY & BLAKISTON.
      1848. 
                            /248




      lEntereft according to the Act of Congress, in the year 1848,
                      By John Hastings,
In the Clerk's Office of the District Court in the Eastern District of Penna.
WILLIAM S. YOUNG, PRINTER. 
                                      Philadelphia, March 22, 1848.
Dr. John Hastings, U. S. Navy,—
    Dear Sir:—Having been much gratified  by hearing your interesting
lectures on Yellow Fever, we, the undersigned, represent the wishes of
the whole audience, in requesting you to furnish us with a copy of those
lectures for publication.  With sincere regard,
                            Very truly, yours, etc.
                                                  W. Darrach
                                                  V. L. Godon,
                                                  A. M. Lynah.
                                      Philadelphia, March 26, 1848.
Gentlemen:—
      I cannot deny your request, if you think this paper is capable of
subserving the least good purpose.  I therefore furnish it without reserve,
trusting more to the judgment of the gentlemen who ask its publicity than
ray own.  I remain, gentlemen,
                    Very respectfully,
                           Your obedient servant,
                                               JOHN HASTINGS.
To
  Dr. W. Darrach, Prof, of Practice, Penna. College.
   " V. L. Godon, of Philadelphia.
   " A. M.  Lynah, of South Carolina. 
 
           LECTURES
                   ON

YELLOW   FEVER.
  Having been thrown in the midst of Yellow-Fever on
several occasions, and yielding to the solicitation of my
medical friends, I have concluded to prepare the following
paper upon the subject.
  The views herein embodied, were not hastily arrived
at; nor were the deductions drawn from slight and insuf-
ficient data; neither were the conclusions leaped at with-
out  due reflection, but on  the  contrary, they are the
result of close and long continued observation, and labo-
rious research; and the conclusions drawn from ample
opportunities, and after the lapse of much time; giving
in this brief form the results  of observations, carefully
made on five separate occasions; in four of which, the
disease was met in  epidemic, and once in sporadic form;
the localities being widely separated: consequently, the
following opinions were formed after the careful watching
and examination of many hundreds of cases; I will not
say thousands, for  that might sound extravagant:  but
certainly, from very many hundreds.
  In the epidemic of last  summer, in the Gulf of Mexico
alone, I was engaged in  the  management  of nearly or
         2 
                          18
quite twelve hundred  cases.  Thus, after examining the
effects of the disease in more than one clime, I have com-
piled the following  condensed account of it, wishing to
be as laconic as possible, consistent with perspicuity;
and if any light be thrown on this  fatal  disease, or the
least good result to the profession  by this effort, I will
feel myself fully compensated.
   Unfortunately, this  disease rests in much obscurity at
present; a difficulty not inherent in the subject, but owing
to our own want of research and investigation, and too
great yielding of opinion to European authorities.
   Thus, M. Louis' ideas are made the constant criteria
of this disease, from the fact that  he once saw it.
   Having been sent, one of a commission by the French
government, to investigate the epidemic at Gibraltar, in
1828; which epidemic seems to have been rather a bi-
lious  remittent,  such  as we  have frequently here, (and
which ran a very fatal course but two years since,)  than
pure Yellow Fever; at  least, one might  judge  so, from
his own writings: for he says, "As then a strict analysis of
the anatomical appearances of the Yellow Fever of Gib-
raltar, of 1828, proves the existence of a cause unequal
in its operation, and of which but one effect is constant,
the specific alteration  of the liver, and as in a third  part
of the cases,  it is  directly to  this cause  that we are
obliged to refer the death, we naturally ask how does this
act, through the medium  of what  system does it exert
its influence on the economy ? "
   Again, he says, " that the severity of the symptoms
does not correspond always with that of the lesions."
   " Of these last, one  only was constant,  the specific al-
teration of the liver." 
19
  " The inflammatory state of the mucous membrane of
the stomach, comes  next  in  frequency, and sometimes
explains in a manner sufficiently satisfactory, the symp-
toms that had been observed."
  Dr. Frank defines Yellow Fever to be " an erysipela-
tous and gangrenous inflammation of the viscera of the
abdomen and other cavities;  sometimes, but not always
accompanied with black vomit, and an icterode condition
of the  skin."  But Dr. Stevens, a high authority, informs
us, " that we have three Yellow Fevers in the western
hemisphere; that one  arises from excessive heat, and is
not contagious, another arises from heat and malaria to-
gether, and the third is contagious, and has its cause in
the emanations from the bodies of those affected."  These
are but  three of the many authorities, whose opinions
have governed all our  views in regard to this fever.
   Certainly, we  who  are so frequently among this dis-
 ease, should know more  about it than Europeans, who
 have  not the same  opportunities for studying it as our-
 selves.
    I presume American intellect, when properly instructed,
 is as capable of investigating disease and judging of its
 causes and effects, as any other; for we have access to
 all the channels of information which the world affords,
 and certainly we should not  doubt our own powers so
 much, as to neglect the closest investigation of nature in
 this disease, which  should be one of the greatest impor-
 tance in the mind of every American physician, since this
 scourge shows itself  yearly in sections of  his country ;
 sweeping  off hundreds,  and spreading with such fearful
 rapidity, that when once it shows itself, leaving no time
  for the medical man then to make himself acquainted with 
20
its proper management.  It should therefore be well com-
prehended, if possible, before encountered.  And this is
not impossible, if proper views upon the disease be the
subjects  of reference  and study.   Few, however, have
been as considerate as Mr. Watson, who, never having
seen the malady, wisely refrains mention of it.   It must
be to  this fact that  we  should attribute  its obscurity
and  contradictions;  from no other  cause can I even
imagine why there should be any serious discrepancy:
for it  is a disease of easy comprehension, and  great
distinctness of character.  Having  no theory to sup-
port, I will present the disease as it  manifests itself to
those who investigate and study it from nature.
  Yellow Fever prevails in, and is generally confined to
Africa, the  West Indies, Mexico  bordering  upon  the
Gulf, and the southern portion of the United  States, but
extending frequently as far north  as Philadelphia, New
York and Boston, all of which  places have  been from
time to time the theatres of its fearful ravages.  It is to
be hoped they may never again be visited by this afflic-
tion : yet the march of epidemics is capricious and well
nigh incomprehensible, and a return of it is quite possible.
Witness its late visit to the south,  where it has raged in
wider extent and greater fatality,  than was ever known
since the discovery of the country.

                   EXCITING CAUSES.
  The exciting causes  of this disease  are  variously
stated.  Dr. Good, in speaking of localities that give rise
to it, says: " Such  places, however, are numerous, as
damp unventilated stations, stagnant water, thick imper-
vious jungles, even high  and arid  hills, after heat and 
21
rain;  but above all, a foul  state of the hold on board
ships, whatever be  the  cause of such impurity."  And
Mr. Bancroft endeavoured to show that it was owing to
decomposition taking place in the ballast of ships, or the
putrid state of the bilge water.
  Drs. Ferguson and Lind attribute its origin to intense
solar  heat, acting either per se, or on wet  and  marshy
coasts.  But Dr. Wilson has singularly enough endea-
voured to show, that this disease is caused by the gaseous
product neither of vegetable nor herbaceous matter, but
of trees, shrubs, or of any sort of wood, in a state of de-
composition.  All this is as incomprehensible as the pre-
valent belief, in many countries bordering upon the Medi-
terranean, of the positive contagion of phthisis.
   The experiments of Professor Julia, of Lyons, led  him
to conclude that "the deleterious influence of Koino-Mi-
asmata, depends upon particles of putrid animal, or vege-
table matter."
   Animal effluvia, alone, is not equal to the creation of
this disease.   If it were, then  wherever animal matter
was found in large quantities in a state of decay, and
undergoing putrefaction, there we would necessarily have
the disorder prevailing.  But upon the dry plains of South
America, east of the Andes, we find  immense masses of
animal matter exposed to the sun and rain, in every state
of decay and  putrefaction.   The  ground being strewn
for miles, with the carcasses of cattle, killed merely for
their hides, and then  left where they were  felled, to rot.
 In many places  they lie several layers  thick, the atmo-
 sphere is filled with animal effluvia, and the air is tainted
 with the disgusting odour.  Yet here Yellow Fever never
 prevails. 
                         22
  I feel perfectly satisfied in my own mind that there is
but one cause capable of exciting this disease; and that
cause is to be found  in  the malaria or exhalations from
alluvial marshy soil, and  that too from marshes subject
to periodic inundation  and draining.  The period  at
which the poison is eliminated is after the draining of ex-
tensive  marshes, and during the process of desiccation.
Close attention to the subject, and well directed observa-
tion make this clear  to the mind, wherever the disease is
found in its endemic form, as it is  only  met with  in
such situations and at such times.  This is clearly proven
by  the  condition of things in the  lower  portion  and
marshy districts of Florida, where the disease is endemic,
and  often  prevails to  a frightful  extent,  and where it
was my fate to see it in its worst form.
  Now here we have the two conditions of soil brought
in immediate contrast;  viz:  That  constantly inundated,
and  that subject to  periodic inundation and draining.
And whilst  the disease is  frequently raging in one situa-
tion, it is never known in the  other.   Thus, when  the
men were operating in the everglades of Florida, during
the late Seminole war, they were  never attacked by the
disease, whilst those  kept  outside upon the  coast, and in
the mouths of rivers, were sickening and  dying of the
fever.
  The everglades are low marshy  districts, having a
coral base, deeply covered by decayed vegetable matter,
and always covered by fresh water, being the sources of
several rivers emptying into the sea.
  Upon approaching the  coast, however, from the inte-
rior, we find these marshes subject to periodic overflow- 
                         23
ing and draining.  And here alone we have the disease,
and that too after the rainy season.
  This, I  believe, is also  the case in every part of  the
West Indies where the disease prevails.  And this was
found to be true in Mexico, in the epidemic of last year:
here also the disease is confined to  the same condition
of soil; for it is not found  upon the elevated and  dry
lands; but always confined to the  districts  of drying
marshes.
   Indeed  there  is so little  difficulty in the subject, that
in the past season, the disease was  predicted at the city
of Tabasco, an  alluvial  marshy  situation, eighty  miles
in the interior of Mexico.
   Those who had seen much of the disease felt positive
it would appear;  judging from the topography  of the
country and the state  of the weather, which had been
very  wet:  heavy  rains  having fallen for some time,
swelling the rivers and  overflowing  the  low country.
The rains then ceased long before their accustomed time;
the country was drained, the solar  heat unusually high,
and the fever in due time made its appearance, and spread
with such rapidity that in a short time two-thirds  of our
force  were down  with  it.  At length the  place  was
abandoned on account of universal sickness.   At this pe-
riod it also appeared upon the coast, wherever the same
condition of country existed.
   Intermittent fever, I  believe, is  universally admitted
to be the result of marsh miasmata.  Now it is positively
certain, that where yellow  fever prevails,  there  also  is
found every variety of intermittent, and very generally
all varieties  of remittent and  bilious  fevers;  these dis-
eases, arising from  the same cause by different degrees 
                         24
 of intensity of the poison.  The  cause of the  varying
 qualities of this principle have never yet been explained,
 nor fully comprehended;  although its  effects are  con-
 stantly observed.
   It has been maintained that miasmatic  matter is not
 Conveyed by the atmosphere beyond a short and limited
 distance,—Mr. Bancroft says  a quarter of a mile,—Dr.
 Eberle agrees with him in a quiescent state of the atmo-
 sphere, and this idea has given rise to the opinion of such
 various  causes  creating  the disease,  as   well  as ac-
 counting for  its  contagious  character: taking it for
 granted that marsh effluvia cannot be conveyed beyond
 a short distance: therefore, other causes had to be found,
 and ingenuity was not slow in furnishing these.  Thus,
 Dr. Chisholm  states, that" ships containing wine in  their
 holds in a state of decomposition, are generally extremely
 sickly, and the character of the prevalent disease is that
 of  yellow remittent fever," and  observes that " several
 instances of this took place in Fort Royal Bay, in the
 years 1787 and 1788; and the situation of the  ships in
 the open bay, far from the  influence of marsh effluvia,
 precluded a suspicion of the fever from that cause."
  And  consequently as miasmatic matter could  not  in
 his opinion be carried to that distance from shore, the
 exciting cause of the disease had to be looked for within
 the bulwarks of the vessel:  and the same idea has been
 extended to cases where persons were presumed  to have
 taken the fever on  shore and then conveyed to their ves-
 sels, when  others on board have afterwards contracted
 the fever, and  that too when the vessels were presumed
to be beyond  the  influence of effluvia  from  the  shore;
therefore, as a matter of course, it must have been taken 
25
from those who brought it on board, and must be con-
sidered contagious for this reason.
  I have never seen a single instance where there was
the least cause to suppose  that the fever originated on
board  ship;  notwithstanding, I have  frequently seen
ships in the conditions  said to give rise to it; and never
saw it  on board  any of them, unless it was prevailing
on shore ; and then even I have seen vessels escape for
a long time, which according to the views before quoted
should  have originated the disease.
  Thus the Raritan frigate in the gulf of Mexico, in
the summer of 1846, was in bad condition, having many
of  the  requisites  for  the creation of the fever,  ac-
cording to Chisholm  and others;  yet  not one case oc-
curred  on board, notwithstanding the very bad condition
of her  crew,  who were suffering so much  at the time
from scurvy,  that she was  almost  unmanned, as shown
by the  report of her  surgeon, Dr. Foltz; but as there
was no fever on shore  that summer, she did not suffer in
the least from it.  Yet in the summer of 1847, when she
was perfectly clean and in good order, without any of
the so called  exciting causes on board, and with  a new
and  healthy crew, she  was the very first vessel in  the
squadron to take the fever.
  The U. S.  steamer  Mississippi, in the early part  of
the summer of 1847, had many of the conditions said to
give rise to  the disease, and was  often so crowded for
many days at a time with men, put on board for expedi-
tions along the coast, that it was  almost impossible  to
walk about the decks; still not one case  of fever oc-
curred at this time.  But later in  the season, when she
had none but her own crew on  board, and  had become 
                         26
clean, and the condition which is thought will give rise
to the fever removed, her crew then took the fever, but
not until it had at first appeared  on shore.
  Bilge water is maintained by some to be an exciting
cause of the fever; but so far is this from being the case,
that in the past summer  the U. S. steamer Vixen, was
so completely  impregnated with bilge  water, that the
white paint in every part of her was blackened, and this
gas was so constantly and  profusely generated, that the
officers and men had to abandon their apartments, and
eat and sleep on deck; and still this vessel escaped the
fever so long, that they began to think she would avoid
it altogether; notwithstanding, the crew of nearly every
other vessel in the squadron was  paralyzed  by it; and
her crew was eventually the very  last in the gulf that
took the fever.
  This idea, that malaria can only be carried a short dis-
tance, I apprehend is an error; but on the contrary, that
it can be borne to  very great distances by the air.
  We can readily  comprehend this, when we take into
consideration to what immense distances from any land,
infusoria have been collected upon  the decks of vessels;
for instance, ships running parallel to the coast of Africa,
at the distance of one, two, and even three hundred miles
from the coast, have had sufficient numbers of  these
small animals found upon their decks, to furnish demon-
strations of many varieties  of animalculae.
  Also  minute fragments  of stone, and  various earths
have lodged upon  the sails of vessels, hundreds of miles
from land; and is it not therefore reasonable to  infer
that material  marsh effluvia can be, and is  conveyed to
great distances through the medium of the air ?  I have 
27
seen this take place, if it be possible to trace cause from
effect.
  In the past summer, there were  a great many naval
and  merchant vessels lying at the  anchorage at Anton
Lizardo, (twelve miles south of Vera  Cruz,) at the dis-
tance at least of three miles from the  shore, with which
there was  no communication, and  yet  men were con-
stantly attacked by the fever,  notwithstanding they had
not left their ships for a long time before the disease ap-
peared.
  Again, upon the Island of Salmadina,  where the naval
hospital  was placed, (at Anton Lizardo also,) but  re-
moved not less than five miles from the Mexican shore,
being a small coral island, perfectly dry and very healthy.
Yet upon  this spot  there were  men attacked by the
fever, who had not been off it  for weeks and months.
  This may be taken as an argument in favour of the
contagious character of the  disease, but it is not  so;
since these cases only occurred during the prevalence of
strong and continued breezes from the land, which inva-
riably produced a great number of cases, and aggravated
the symptoms of those already sick.  The very reverse
was the  case during the prevalence of strong  and con-
tinued breezes  from seaward: these never failed to re-
duce the number of cases, and improve  the condition of
the sick, so that the prevalence of the winds became al-
most as certain an indication of the number and condi-
tion of the sick, as the thermometer of  the temperature
of the air; and the heat was excessive that season, as I
believe it always is, when the fever prevails to any great
extent;: it ranged from 90° to 100° in the shade, the ordi-
nary degree being 86. 
28
                      CONTAGION.
   The opinion of the profession does not seem perfectly
settled as to the contagious or non-contagious character
of Yellow Fever.   Dr. Gregory is very positive upon the
subject, and expresses himself in the strongest terms,
saying  that "no  reasonable  doubt can surely be enter-
tained, by  any candid, intelligent, unbiassed man, that
this disease, being once received into a town, is conta-
gious."   And  Dr. Stephens maintains that "the disease
is  at  all times essentially and absolutely the  result of
contagion."  But Dr. Elliotson takes a neutral course,
and says, "I  believe  that the  greatest authorities in
America are satisfied,  that the Yellow Fever is, for the
most part, not contagious; but that it is sometimes con-
tagious,  appears  very certain."   And this matter is
agitated, and  its  contagious character insisted  upon, by
Dr. M'William, of the British navy, in a recent report
made to the House of  Commons, upon the fever at Boa
Vista, one of  the Cape de Verde Islands; but it is ob-
servable that this  report alludes to a condition of country
at Boa Vista,  capable  of  exciting the disease, without
taking the fact into consideration.   And it uses a still
stronger argument against itself, in regard to the conta-
gious character of the disease; for it states, that  there
could only be found five well  authenticated cases, where
natives had suffered a second time from the fever.  Thus
showing that Yellow Fever is no new or accidental dis-
ease at  Boa Vista.  And in this, as in many  previous
instances, the idea of contagion is promulgated  from the
mere coincidence of a ship's arrival at port, with  the
appearance of the disease at said place.
  Having seen so many persons exposed upon repeated 
                         29
occasions, within the undoubted distance  of contagion
or infection, without  contracting the disease.  That it
appears  to  me impossible  to have  been the  case, if
there had been either of these properties existing.  Hu-
manity even demands that the idea of contagion should
be eschewed by the  profession in every epidemic dis-
order, unless it be so beyond the shadow of a  doubt;
since it calls forth the worst features of the human heart
in its ungovernable terror, and causes even  the  mother
to desert her dying child, and the sick to languish un-
cared for and shunned.
   Certainly, there seems to be no reasonable ground for
the belief of contagion in this disease. How is it possible
to maintain it, after the dangerous experiments of Dr.
Firth, of Philadelphia, upon  himself? as  tasting black
vomit, and inoculation with it, and the serum and saliva
of patients with this fever.   I have, myself, slept for a
considerable time, on repeated occasions, (for want of
better quarters,) under  the same roof and in immediate
contiguity with patients labouring under every stage of
the disease, from the first day of the attack, to the last
hour of existence.  I have also cut myself with a  scalpel,
when handling black vomit, and the other fluids and tis-
sues  of patients who died of yellow fever; and still suf-
fered not the  least inconvenience from this contact and
exposure.   And I  do not believe the exhalations from
the bodies of those affected, have the least  effect in re-
producing the disease.  Doubtless, the vitiation  of the
air by means of these effluvia, is a strongly predisposing
cause, in the  same degree that an impure  atmosphere
from any other cause would be, and certainly is.
   It would  not be possible, I think, to create the disease 
                         30
in a person confined with  and waiting upon any number
of those having it, provided  they were removed from the
district where the disease was contracted,  to a position
known to be free from its invasion, and attended by one
who had  not been exposed to the disorder,  otherwise
than by  contact with those affected  by it.  Indeed, I
have seen this state of things, and under it never saw
the disease contracted.   Thus, at Indian Key, Florida,
where  the Naval hospital was situated in the epidemic
of 1841 and '42; patients were brought in every stage
of the disease, and  even the  bodies of those who had
died of it at other places; yet there was not an  indivi-
dual case occurred upon the island.

                PREDISPOSING CAUSES.
  The predisposing causes  are numerous.  Any thing
that disturbs the healthy  and regular action of the sys-
tem, predisposes to the disease, particularly exposure to
the heat of the sun at mid-day, and the  dews at night.
Excess in eating and drinking, particularly  the latter; a
debauch  in drinking is almost certain to  lay open the
system to the approach of the  disease, since it carries in
its train many other imprudences, equally dangerous with
itself, such as great exposure to the sun and cool, damp,
night air.
  Breathing impure air:  thus an atmosphere laden with
particles  of putrid animal or  other vitiating matter, is
highly predisposing to the  fever, from their deleterious
effect upon the general health of the system.  Constipa-
tion of the bowels  is  a very great predisposing  cause,
and therefore much attention should  be paid to keep
them in regular and healthy  action.  Fear, or great dis- 
31
turbance of the nervous  system, from any cause.  And
it  is probable that  the disease may lie dormant in the
system for many days.

                     SYMPTOMS.
  The premonitory symptoms of yellow fever are felt 24
or 48 hours before  its undoubted invasion.   They con-
sist in a  giddy indescribable sensation of the head, with
constipation of the bowels, and slight aching of the limbs.
At the termination  of this period, the disease manifests
itself suddenly.
   In some cases  the onset of the disease resembles hy-
sterics, from the  agitated condition of the  nervous sys-
tem.   In others, the person is suddenly deprived of con-
sciousness, and falls  to  the  ground as if felled by the
blow of a mace.  These  degrees of violence are unusual,
although they occasionally occur.  Yet they never com-
plicate  the disease; passing off in a few hours, leaving
the patient in the same condition as those more mode-
rately shaken by it.  These are the exceptions to the ge-
neral rule.
   The almost universal  approach  of the disease is indi-
cated by sudden sickness of the stomach, with vomiting;
violent pain in the head, back parts of lower extremities,
knee joints; and often severe pain down the anterior part
of the leg.   And there is a creeping sensation down the
spine, with  rigor.  The countenance   is  flushed and
swollen.  The eyes  are prominent  and injected with
blood;  having a peculiar glassy appearance, and heavy.
anxious, stupid expression; which when once seen, can
never  be forgotten.  The  tongue is moist  and  covered
with a white fur, with   tip and edges pinkish.  Bowels 
32
 constipated;  pulse small, sometimes barely perceptible,
 and skin cool.
   These symptoms continue six or eight  hours;  the pa-
 tient still continues to feel a  sensation of coldness, and
 wrapped in blankets, even after the skin,  to the touch of
 another, is quite warm.
   To these symptoms of the cold stage, succeed burning
 heat of the skin; violent pain in small of back, with ag-
 gravation of all the other symptoms; a slight pain upon
 pressure over the stomach and  right hypochondrium,—
 the vomiting continues from time to time, though never
 very severe or causing much pain.  The  matter  ejected
 at first is  the ordinary contents of the stomach.   Arti-
 cles are sometimes thrown from the stomach in  almost
 an unaltered condition, which had been taken 24 hours
 previously; and these cases are almost always severe;
 showing the deranged powers of digestion at this time.
 After a few hours, the matter vomited becomes smaller
 in quantity;  green  and bitter; consisting almost of pure
 bile.  The tongue gradually becomes covered with a yellow
 fur;  the tip and edges growing red.—A severe throbbing
 pain shoots across the temples, with strong pulsations of
 the temporal arteries.  The pain in  small of back in-
 creases, and is generally more persistent and severe than
 the pain of head.  There is very little pain  in the epi-
 gastrium and region of the liver.  There is loss of ap-
 petite, with constipation and diminished quantity of urine,
 which is of dark colour.    Although occasionally this se-
 cretion is found in preternaturally large quantity, and of
light colour.   The  alvine evacuations are  sometimes
found to be rather frequent, but not often  so.  There is
restlessness with loss  of sleep.  The skin is very hot, 
33
dry and flushed.  The pulse is  small  and frequent, but
not quick; being generally from 80 to 90 pulsations in
the minute; it is mostly a  masked pulse; one though not
strong, yet indicating strength, that is to  say, a pulse
which conveys the impression to the touch  and mind, of
being  restrained; not having  the  power of developing
itself in  its full force; and generally increases in force,
whilst the  blood is flowing from the  use of the lancet.
Often it  is observed to be full, strong, and bounding, with
great  force, but without frequency.
   At this time insatiable thirst comes on, and this symp-
tom continues throughout the disease, and gives more
annoyance to the patient than all the others.
   There is very little loss of strength experienced by
those affected with, this fever.   So little is it felt, that
one of the greatest troubles in managing these cases, is
to keep  the patients quiet in bed.  They have a constant
disposition to move about, and tell you they feel " very
well," as if nothing were  the  matter with them.  This
often occurs  in some of the  most fatal and intractable
cases, and of course  much harm  is frequently done by
this  unfortunate feature of the disease.   Therefore the
" walking cases of fever," as they  are called, are not un-
 frequent.   Notwithstanding this moving about, the dis-
 ease is not altered or interrupted in its course, but pro-
 ceeds regularly step  by step, and occasions dissolution
 generally  upon a certain day.
   This  feature of the disease, I suspect, has often given
 rise to the belief that patients have died of yellow fever,
 after  twenty-four or forty-eight hours' illness,  because
 they were seen at this period for the first time, or had not
 been longer confined  to their beds.  There was  such  a
       3 
34
 case occurred in the  Hospital at Salmadina:  James E.
 Ringrose, marine, was brought in from the U. S. store-ship
 Fredonia, and died twenty-four hours after, with black
 vomit.  This man was said not to have been sick before
 he was sent to the hospital;  but upon examining the ser-
 geant who had charge of the marines, he informed me
 the man had been taken sick six  days previously, he
 did not want to  go to the hospital, and said he was not
 too sick to do his duty, and he allowed him to do it as
 well as he could without  reporting him sick, as the duty
 was light, and only came once in three or four days.
   Doctor Bates  of the U. S. steamer Vixen, was another
 case of the kind, who came to the hospital in  the last
 stages of the disease, and died in about fifty-six hours
 after, with black vomit.   But the doctor informed  me,
 that he had been sick for more than four days previously.
 As his symptoms  were  mild, he  thought very  little
 treatment  would suffice to restore him to vigour; and
 being opposed to active treatment in the disease, conti-
 nued moving about, and did not send for aid until it was
 too late.  Yet this restlessness and consequent neglect,
 often renders a  case fatal that would otherwise be sus-
 ceptible of cure.
   During  the first twenty-four hours  of the hot stage,
 there is often a well-marked remission in the fever.   The
 skin becomes cooler  and pulse  more  natural, with  an
abatement of all the symptoms;  and it is not unusual to
have the skin even moist with perspiration.  Yet the re-
mission is of very short duration, when all the symptoms
return with their original force.  And thus the disease con-
tinues in its course without remission for about 96 hours, or 
35
until the commencement of the fifth day, when a rapid
change occurs.  Now the tongue  and lips are becoming
dry, and covered with a dark crust, particularly the cen-
tre of the tongue, its tip and edges looking like raw-beef.
The vomiting becomes more frequent, but without much
effort;  the matter ejected  assuming a glary mucous ap-
pearance, with an occasional dark shred or spot mixed
with it.   The sclerotica  has a yellowish hue, and the
skin begins  to take the same shade.  The bowels are
moved occasionally, the dejections being dark-coloured
and liquid, passed in some cases very often.  The  mind
at this time begins to give way; the patient comprehends
slowly, and looks at you with a  bewildered expression
before he gives an answer.
   By the sixth day, (sometimes commencing on the fifth,)
 there is coma, from which  the patient is roused with a
 wild stare; the mind totters thus until it is entirely lost
 towards the close of the sixth or beginning of the seventh
 day, when there is an occasional  vomiting of dark brown
 or blackish matter, in a glary mucus, and which has been
 very correctly likened  to coffee-grounds,  to which  it
 bears a  striking resemblance.   This vomiting of black
 matter continues  until death: it  is ejected without diffi-
 culty, and frequently in large  quantity; its appearance
 always alarms the patient, if he be conscious, and for the
 first time during his illness, he begins to think himself in
 danger.
    There is frequently, from the fifth to the seventh day,
 hiccough;  bleeding from the  gums and mucous  mem-
 brane of the mouth, which dries upon the lips and tongue;
 continence of urine, from atony  of the bladder.
    Towards the close of the seventh clay, there is deep 
36
 coma and  low muttering;  the/patient becomes restless,
 and frequently throws  himself about.  The  surface of
 the body and  albuginea assume  a decidedly  yellow co-
 lour.   The features are contracted or pinched up.  Oc-
 casionally  there is most violent convulsion:  but gene-
 rally it does not  pass  beyond mere restlessness; still
 I have seen  convulsions  so  strong during the last
 hours of existence, that four stout men have been scarcely
 able to keep the dying man upon  his bed:  and the pa-
 tient dies almost universally on the seventh day: yet in
 some instances it occurs at a later period.
   This is the regular march of the disease to its earliest
 termination, where death by the fever is not anticipated
 by any accidental condition of the system, such as dis-
 ease of the heart, large arteries, or strong predisposition
 to apoplexy.  This last mentioned condition is a frequent
 cause of death upon the third or fourth day.
   I  found, in three cases, large clots of coagulated blood
 resting  upon the superior surface of the  brain, beneath
 the dura mater.   In two cases a large amount  of bloody
 serum was  found in the ventricles of the brain, at its
 base, and in the spinal canal, with astonishing conges-
 tion  and distention  of all the blood vessels of these parts,
 both upon  the surface and  within  the substance of the
 brain.   These  patients died upon  the fourth  day, with
 stertorous breathing, and all the signs of apoplexy, which
 was  evidently induced  by the powerfully exciting action
 of yellow fever, upon an apoplectic diathesis.  But where
these accidental circumstances do not interrupt  the re-
gular progress of the disease, death occurs, as heretofore
stated, on the seventh day, and after the manner already
described. 
37
   There are several symptoms which indicate great dan-
 ger, and when observed, should excite the deepest solici-
 tude on the part  of the  physician, since the life of the
 patient will frequently depend upon the skill exercised in
 the management  of the  case  at this critical  period.
 The unfavourable symptoms are coma; bleeding  from
 the gums and mucous membrane of the mouth; frequent
 alvine  discharges of  dark  liquid character;  vomiting
 glary mucus-looking matter.
   The highly dangerous  symptoms are, a  collapsed ex-
 pression  of countenance, and sharp pinched appearance
 of the features; retention of urine;  increasing yellow-
 ness of albuginea; vomiting glary matter,  with dark-co-
 loured spots and  shreds  intermixed,  or positive black
 vomit.   Hiccough is  unquestionably  one  of the most
 dangerous symptoms of the disease.  It frequently makes
 its appearance as early as the fourth day, but generally
 on the fifth; and it is remarkable that it is observed often
 at a time when the  patient appears to be convalescent; and
 the most  skilful physician, inexperienced in this disease,
 would pronounce  him  out of danger, and doing as well
 as could be expected.  But this  symptom alone conveys
 to the mind of the experienced  in the disease the most
 anxious  solicitude and forebodings of approaching evil,
 notwithstanding the other favourable appearances.   He
 therefore  redoubles his attention to the case, past expe-
 rience having taught him that few recover after  its oc-
 currence.  This delusive  pause, which  appears  some-
 times even without this symptom, is a very remarkable
 feature in the disease;  for at this time, (about the fifth
 day,) there is frequently a perfect cessation of all pain and
anxiety; the skin and pulse seem quite natural, and the pa- 
                         38
 tient is full of hope and in good spirits, thinking himself en-
 tirely out of danger, and  seems to imagine his medical
 attendant is confining him to his bed unnecessarily; he
 vomits occasionally a glary mucus or pale greasy-look-
 ing  matter, and may have hiccough; but these he ac-
 counts for in the most natural manner, from something
 he has drunk or eaten, and  tries to persuade you  he is
 quite well again; and so any one would think who was
 unacquainted with the disease.   But to the mind of the
 intelligent  physician,  initiated in the mysteries of the
 fever, this apparently happy, but delusive respite from all
 pain and inconvenience,  when  accompanied with  this
 symptom of hiccough, creates almost hopeless anxiety.
  I  have never seen a case recover, where undoubted
 hiccough had regularly set in;  notwithstanding, I  have
often observed it  make its appearance when the patient
 was  perfectly easy, and his condition in every  other as-
 pect seeming favourable.
  Nor have I ever seen a  case recover,  after positive
black vomit had been thrown from  the  stomach, but
have on  some occasions heard of such cases, and always,
upon tracing  them out carefully, have found that in-
stead of positive black vomit, from which they had reco-
vered, that it appeared like black vomit, but was nothing
more than the black or  dark  brown fur, which often
coats the tongue and lips: and in other cases consisted
of the dried blood which  had  oozed from the mucous
membrane of the mouth, and thus gave rise to the report
of black  vomit;  thus, after striving to see  a case of re-
covery from black vomit, I have always been disappointed,
and  as yet  out of hundreds of cases, have  never  seen
one.   I therefore  conclude they are at least extremely 
39
rare, and must admit that I have no hope of recovery
after its appearance.  This deceptive hope and apparent
gleam of sunshine in these fatal cases, arises doubtless
from  the  complete mortification of the mucous mem-
brane of the stomach.
   It is frequently the case, that the onset of  the disease
is of so mild a character, that the subject of it continues
walking about  for five or six days, thinking himself not
very ill, and even refusing to consult a physician until black
vomit appears, and he dies on the seventh day; not being
upon his  back probably more  than twenty-four hours;
indeed, some of the most intractable and fatal cases are
 those of which the early symptoms  are  the mildest, and
 apparently inconsiderable;  so  that  the  violence of the
invading approach of the disease  is no indication of its
danger,  or  its  liability  to  proceed to a fatal  issue.
 Therefore it is necessary to  be  on the watch for, and
 fully  aware of this insidious form  of the disease.
   The fever has now been described  as it runs an un-
 broken course, observed from its first onset until its final
 termination  on the seventh day.   Yet  there are  some
 cases that do not  terminate  fatally for ten days, two
 weeks  or more: these  cases  are probably seen for the
 first  time, after the disease  has  had  almost  uninter-
 rupted sway for five or even seven  days.  The  pa-
 tient at this time is unable to give any account of his
 case;  he is comatose;  with  skin  and albuginea of a
 yellow tinge;  tongue and  lips incrusted with a dark
 brown fur;  the tip and edges of tongue  looking like raw
 beef; bleeding of the gums; great thirst; pulse frequent,
 weak and small; bowels constipated or frequently moved,
 the dejections being dark-coloured; urine  dark and in 
40
small quantity; there is frequently retention of it.  The
skin in these  cases is yellowish and  dry, with burning
heat, and is  sometimes  studded with petechia?.  The
matter ejected from the stomach either has a pale glary
or greasy appearance, or may be positively black vomit.
  These cases linger  sometimes for many days, or even
weeks or months, and die eventually of softening of the
brain, spinal marrow,  liver, and intestinal mucous mem-
brane; or by proper and judicious management, may
sometimes recover.  This may be  called  a second view
of the disease, or presenting it under a new aspect.

  We have now but two points left in the consideration
of this disease, yet these are of the  greatest possible
importance; they arc its Pathology and Treatment, both
of which  it  is indispensable to fully comprehend, after
recognising the disease  through the medium of the ma-
nifested symptoms.  And as the treatment is based upon
its pathology and cannot be perfectly  comprehended, or
its adaptability fully appreciated, until the mind has  a
clear, fixed, and positive knowledge of the latter, I shall
therefore take it up first, as being properly next in order,
and examine  the subject fully, to see what organs come
within the boundaries of its destructive influence, and
what the  nature and  extent of the changes created by
this diseased action.

                     PATHOLOGY.
  Here I am forced  to differ with some very high au-
thorities, but as I have no hypothesis to support, and in-
tend merely to describe what nature and disease present 
41
to observation, I cannot be  responsible for the discre-
pancy, since nature never errs; but books, being subject
occasionally to exceptions (like the best of rules,) some-
times do; and without further prelude I will pass to the
examination  of the  pathology of the yellow fever,  as
found in cases running a regular course and terminating
in death on  the  seventh  day;  examined  six, twelve,
eighteen, and twenty-four hours after death.
   The exterior surface of the body which at the hour of
death  is yellowish, darkens in  a few hours  after into a
deep  dirty  orange  or  lemon  colour, about the  neck,
side face and genital organs, assuming  the  peculiar ec-
chymosed  appearance of persons poisoned by arsenic;
the sclerotica is equally yellow with the skin;  and there
is very little  odour arising  from the body.
   The  brain and  its membranes  show in all cases re-
sults of active and extensive disease.  The substance of
the brain is  rather firmer  than natural, and completely
engorged with blood, both upon its  surface and interior
structure:  the ventricles are generally filled with a yel-
lowish or bloody serum, although in  some cases they are
preternaturally dry;  yet the amount of bloody serum
contained  within  the cranium generally  is very large.
The substance of the brain is so fully charged with blood,
that when the medullary matter is cut across, numerous
points bleed freely; and its whole structure is so coloured
by the amount of blood contained in  it, that there is but
little difference existing between the medullary and  cine-
ritious matter.
   The  membranes of the  brain are  all thickened; the
dura-mater particularly so  in  the region of the superior
longitudinal sinus;  and the glands of Pacchioni are very 
42
much enlarged.   The  arachnoid  membrane is greatly
thickened, of a pearly hue and tears with difficulty, com-
pared with its delicate normal condition.
  The pia-mater is thick and whitish, like the arachnoid,
to which it is firmly adherent; there is often a quantity
of partially organized lymph thrown out upon the sur-
faces of these two membranes, sometimes  an  eighth of
an inch in thickness, and I  have even seen it nearly a
quarter of an inch thick; having found these two cover-
ings so thickened and strengthened by the process of in-
flammation, that I have held suspended the whole mass
of the brain, engorged as it is, and with the dura-mater
attached, by these two delicate membranes, that in their
natural condition break at the slightest touch.
   The alterations of the spinal marrow and its membranes
 are  the same as those found in the interior of the cra-
 nium.  The vessels of the membranes of the  brain and
 spinal marrow are greatly distended with blood.
   The heart and lungs are  not at all affected  in yellow
 fever.  But very important changes occur in some of the
 abdominal viscera: as the stomach and liver.
   The stomach is filled with or contains a large quantity
 of black vomit;  its mucous membrane is thickened to
 twice its healthy condition;  it is dark-coloured, softened,
 and in a state of sphacelus, and frequently removed in
 large patches, particularly  about the cardiac  orifice,
 where I have seen a surface as  large as  the  hand, en-
 tirely bare  of this membrane.   But generally it is re-
 moved in smaller patches.   And throughout  the rest of
 its  surface, it is  so soft that it is easily removed by the
 handle  of  a  scalpel,  or  the finger-nail,  and  it is also
 about this orifice and smaller curvature, greatly injected 
43
with blood.  Throughout its surface, are small bright scar-
let spots, looking so much like a fresh drop of blood, that
I have seen  the finger of those unaccustomed to these
examinations, passed over them, thinking to brush these
stains away.  But they are fixed  in the mucous mem-
brane.  This condition extends to  the  pyloric orifice,
but here it stops; from this out, the intestines both large
and small are unaltered and natural, with the exception
of a slight degree of congestion or injection of the mu-
cous  membrane of the duodenum: the whole  of this
membrane is in its normal condition.
  The liver undergoes a very great change.  It is rather
contracted, and of a yellow colour, resembling very much
 the colour of old box-wood: this is particularly observa-
 ble on the  anterior part  of the right  lobe;  although it
.pervades  more or less its  whole structure.
   Its substance is very much firmer than natural;  indeed
 it is almost of a cartilaginous  consistence:  so much so,
 that it is nearly impossible to penetrate a piece of it with
 all the force one can  exert, when holding it  between the
 fingers and thumb.  It cuts with a hard shining surface,
 and tears rather smoothly; its normal or granular appear-
 ance being almost or entirely gone.  It is probable that
 its eliminating or secreting power is entirely lost, which
 accounts  for the large amount of bile colouring the tis-
 sues and  the serum of the blood.
   The gall bladder is natural, and contains a moderate
 quantity of dark bile.  The spleen is unaltered, except
 in cases where the deceased  had  suffered from frequent
 attacks of intermittent fever: in these cases  it was en-
 larged and softened.   No other alterations are observed
 in  the abdomen. 
                        44
  Thus we find  in every pure  case of yellow fever, the
following organs affected, and  none others;  and these
always and in every case, presenting precisely the pa-
thological changes already described; namely, great con-
gestion and hardening of the brain and spinal marrow;
with thickening of their membranes: congestion, soften-
ing and sphacelus of the mucous membrane of the  sto-
mach, with the removal  or loss of part of its  surface:
and contraction and almost cartilaginous hardness of the
liver.
  These comprise  all the changes effected  by a fatal
attack of the yellow fever terminating upon the seventh
day.
  In the second case, wherein the disease comes to a
fatal issue upon  the fourteenth day or at a later period,
very different pathological appearances present themselves.
In these cases, the  brain and  spinal  marrow are soft-
ened ;  their membranes are thickened, and there is ge-
nerally  a very large  amount  of yellowish  or bloody
serum within  the cranium and spinal canal.  The heart
and  lungs are healthy.   The stomach is  in much the
same condition as  already described.  But the mucous
membrane of the duodenum, small and large intestines,
is greatly injected, thickened, and softened; of very dark
colour, and in some cases removed or destroyed in patches.
The glands of Peyer and Brunner are  injected and en-
larged.   The whole tract of the mucous  membrane re-
sembling the change  of structure met with  in patients
dying of typhus fever, but not to the same extent.   The
stomach is sometimes filled with black vomit, and the in-
testines contain dark matter resembling it.  The mucous
membrane of the  bladder is injected with  blood, and 
45
spotted with many scarlet puncta.  The spleen, if altered
at all, is rather softer than natural; but  in cases where
the subject had laboured under intermittent fever of long
standing, it was invariably of large  size and  very soft.
The liver is  engorged with dark blood; about  natural
size, of dark colour and softened.  Thus showing at this
advanced or protracted stage of the disease, a complete
breaking down of the structure of the brain, spinal mar-
row, liver, and mucous coat of the stomach and intes-
tines.  The  skin  upon the thighs, arms, abdomen and
breast, is often covered with petechias.   The  albuginea
and the whole surface of the body is much darker in co-
lour than those dying at an earlier period.  This is ob-
servable even before death takes place.  The lips, tongue
and gums are covered with a dry brown crust, the tip and
edges of tongue red, and almost or quite raw.  There is
little or no emaciation of body.  And I have never seen in
any case, the least reason to suspect any change in the
dimensions either  of the. stomach  or intestines.   The
kidneys  and  other viscera are found to be in normal
condition.  The blood remains in its liquid state in those
who die; but there does not appear  to be any peculiarity
in that taken from yellow fever patients.   It is observed
to be cupped, has the buffy coat and same appearances
as all blood taken from those suffering by active inflam-
mation and a high state of fever.  It contains, doubtless,
a large amount of bile or its constituents, owing  to the
crippled or suspended functions of the liver.
   Black vomit is of a dark brown colour generally, but
is sometimes nearly black; I have  seen  it occasionally
 the colour of tannate of iron: it exists in shreds or floc-
culi, floating  in  a greasy or  glary looking fluid,  some- 
46
times pale, but generally dark-coloured, and the shreds
or flocculi appear frequently like portions of the mucous
membrane of the stomach, stained by the altered condi-
tion of the blood, in its substance; many of these adhere
to the sides of the vessel into which they are thrown.
The composition of  black  vomit  has been  variously
stated to be, either an altered  secretion of the stomach,
or vitiated  bile meeting with peculiar substances in this
organ, and thus giving rise to  this pathognomonic sub-
stance.   But its true composition, beyond all reasonable
doubt, is pure  blood mixed or combined with hydrochlo-
ric, or acetic acid;  physiological research having disco-
vered these acids existing in the stomach in a free state.
It cannot be bile, since it exists in such large quantity.
The amount of bile found in  the gall-bladder is  very
small, and none at all found in  the stomach or intestines;
whilst the  liver is not in a condition to secrete  it in
large quantity, if at  all.  Now where does the large
amount thrown off from the  stomach during life, and
found in this organ after death, (amounting  sometimes
to pints,) come from?   From the blood, most certainly.
And it is easily accounted for.   The mucous membrane
of the stomach is softened and broken down; and this
membrane, than which there is none in the system more
plentifully supplied with blood vessels, indicates a strong
predisposition  to the exudation of blood, as observed in
the throat, and that lining the mouth and gums; which
at this time (about the  fifth day,) bleed profusely, by
transudation throughout its surface.  And of course the
amount of blood transuding through the soft, broken down
structure of this membrane lining the stomach, must be
very great.  It collects in the stomach, where it meets 
                         47
with free muriatic acid;  and the combination of these
two liquids, forms this peculiar  black  matter.  A sub-
stance can be made, by the admixture of diluted venous
blood with muriatic acid, so like that ejected from the
stomachs of those who have died of yellow fever, that I
defy the most experienced eye to detect  the difference.
Indeed it cannot be done;  and I  have produced speci-
mens of them side by side, to those in the habit daily of
seeing black vomit, and  never knew any one who could
tell the fabricated from the  real, from  the fact that they
 are precisely the same.
   Thus after careful consideration of the manifestations
 of this disease, together  with the pathological alterations
 observed in  it, I am fully of opinion that the immediate
 or most active cause of death, must be looked for in its
 effects upon  the brain;  since  the  diseased condition of
 the liver and stomach would not destroy life in so short
 a time, although they certainly assist the brain and its
 appendages very much, in  hastening its final conclusion.
    It may seem presumptuous, still I must confess I can-
 not comprehend Monsieur Louis' account of the patho-
 logical appearances discovered in the fatal cases of yel-
 low fever at Gibraltar in 1828; for he admits he is en-
  tirely at a  loss to account for the death, and shows  at
  the same time,  that he  never inquired into the condition
  of the brain and spinal marrow, but passes them by with-
  out a word, and even without observation.  Nor, indeed,
  can I understand what he observes in  regard to the al-
  tered dimensions of the stomach and intestines.
     Thus the pathology  given by Monseiur Louis is as fol-
  lows :
     " The stomach was  larger than natural in seven sub- 
48
 jects, smaller than usual in three.  It contained  a clear,
 or dark red-coloured liquid, a blackish, or perfectly black
 fluid in different quantities, in three-quarters of the cases.
 Its mucous membrane was red, through a greater or less
 extent, in  six cases; rose-coloured or orange  in eight
 cases;  grayish, yellowish  or whitish in others.  It was
 thickened through a greater or less extent of surface in
 half the cases; softened and yellow to an extreme degree
 in the same number; at the same time, thickened, softened
 and red in a third part of the cases; mammillated in two-
 thirds ; ulcerated  in two  cases; it was natural  in  five
 cases.  The mucous membrane of the duodenum  was
 red in a little more than half the cases; softened in the
 same number, and thickened in one case.   The small in-
 testines contained a greater or less quantity of reddish,
 brownish, blackish,  or  perfectly black  matter,  in  two-
 thirds of the cases.  Its mucous membrane was slightly
 injected or red, in spaces, in a little  less than half the
 cases.  Its consistence was  more  or  less  diminished
 through its whole length, or through a part of its extent
 only, in  rather a greater number of cases.   It was par-
 tially thickened in  one case; in no case was it ulcerated;
 and Peyer's glands were always natural.  The large in-
 testine was  of a greater size than usual, in two cases.
 In fifteen cases it contained a matter of a  wine-lees co-
 lour, or blackish, or brownish, or chocolate-coloured, or
 entirely black.   Its mucous membrane was of a pale, or
 bright red  colour  in five  cases; grayish,  yellowish, or
whitish  in the others. Its consistence was  more or less
diminished  in three-quarters of the subjects.   Its thick-
ness was increased in three cases; and twice we found
it slightly ulcerated.  The  mesenteric glands presented 
49
traces of inflammation in four cases; the cervical glands
in one case;  in  another case one of the  glands  above
the biliary ducts was red, softened and very large. The
liver was of greater size than natural in two cases; a
little firmer than usual in three cases; a little less firm
in three others.  Its cohesion was increased in six cases,
diminished in seven.  Its colour was altered in every
case; sometimes it was the colour of fresh butter, some-
times of a straw yellow, a clear coffee  and milk colour,
sometimes a gum yellow, sometimes of an orange colour.
The spleen was softened in eight cases, and to a mode-
rate 'degree, with  one  exception.   It was larger than
usual in five cases.  The lesions which  we have thus
placed before the reader, were rarely considerable, very
often insufficient to explain the death, and when this ex-
planation was afforded, it was by a combination of seve-
 ral lesions.  These  lesions may be  divided into two
 classes, some of them peculiar or almost exclusively pe-
 culiar to subjects dying of yellow fever; others common
 to those subjects, and to subjects who have died of other
 acute diseases.  The red or black  matter found in the
 alimentary canal, and the  remarkable alteration of the
 liver, are of the first class, all the  other  lesions of the
 second.  The red  or black matter of the stomach or in-
 testines not having been found in all the  cases of yellow
 fever, it cannot be considered  an anatomical character
 of the disease.  But it is  not  so with alteration of the
 liver, which was more or less exactly the same in all the
 cases, and which, for that reason, ought to be considered
 as the  essential anatomical character of the yellow-fever
 ofGibraltarofl828."
    " Amongst the lesions of the second class, the yellow-
  ness and the inflammation of  the mucous membrane
        4 
                         50
of  the stomach  should  be  especially  remarked,  as
well from their frequency, as on account of the rapidity
with  which  they  come  on.    The   inflammation  of
the  mucous  membrane of  the  stomach  not  having
taken  place in all the  cases, and Peyer's  glands not
having ceased to be natural, it follows, on the one hand,
that the yellow fever of Gibraltar of 1828, is not a gas-
tritis, and on the other hand, that it is not a typhoid fe-
ver.  This last conclusion is even  more strict; for not
only was there an absence of the lesions of typhoid fe-
ver in the bodies of the victims of yellow fever, but these
bodies presented other lesions which are not found in the
victims of the first disease, and which are peculiar to the
second disorder."
  " What, then, is the nature of the yellow-fever of Gib-
raltar  of  1828,  and where  is the  seat of it?   If it  be
neither a gastritis  nor  a  typhoid fever, neither is it  a
hemorrhage, as it  has lately been said to be; for the he-
morrhage did not take place in all cases.  Is it a disease
of  the liver?  Undoubtedly the liver was the organ
principally and  essentially affected: still we cannot re-
gard the yellow fever as simply a  disease of  the liver,
because its lesion, at least  in  the  present  condition of
science, does  not  explain the febrile symptoms in the
cases where this was the only lesion;  and in the second
place,  because it  is  entirely insufficient to  explain the
death."
  "As, then, a strict  analysis of the anatomical ap-
pearances of the yellow-fever  of Gibraltar,  of 1828,
proves the existence of  a cause unequal in its operation,
and of which  but one effect is constant, the specific al-
teration of the liver, and as in a third part  of the cases
it is directly to this cause that we  are  obliged to refer 
51
the death, we naturally ask how does this  act, through
the medium of what system does it exert its influence on
the economy?  Is it  through the nervous system, is it
through the blood, in which, however, we have not de-
tected any special modifications?"
   Does Mons. Louis wish us to infer that the muscular
and cellular coats of the stomach are affected in this dis-
ease  or not?  For  certainly the mere  softening  and
thickening of the mucc us membrane as he describes it,
could not increase the dimensions of the stomach, nor
would it decrease it.  Still he does not mention a word
about any altered condition  of the cellular or muscular
coats, without which it  would be impossible  to have its
capacity materially affected,  and as for judging of slight
variations in the size  of this  organ, every anatomist
knows it  is  impossible; for  the natural dimensions of
the organ in different  individuals, is almost as various
as the number examined; being capable  in  its normal
condition of containing  in  some  cases  about a pint,
whilst in other cases it  will contain several.

                     TREATMENT.
   Having now carefully examined all the  organs  and
parts of the system  altered  by  this  diseased action, as
well  as the nature and extent of these  alterations, we
come directly and naturally to the consideration of its
proper mode of management or treatment.  And this be-
comes self-evident, when we  look at  the symptoms and
the altered structures.  It seems impossible that there
could exist but one opinion  upon the subject;  it is as
clear as the noon-day sun.
   In  the  former, we  discover great disturbance  of the 
52
nervous centres, producing effects similar to  hysterics,
or causing a  lifeless fall  to  the  ground, or a feeling of
phrenzy.   Great heat of skin; tenderness upon pressure
over the stomach and liver; great thirst and ejection of
every thing swallowed;  violent throbbing pain in head
and back, with sleeplessness, cramps in extremities, coma
and convulsions.  These, taken in connexion with post-
mortem evidence, are sufficient to convince any one of the
existence of the most violent inflammatory action going
on in the substance and  membranes  of the  brain and
spinal  marrow.  And the  condition of the  liver and
stomach, produce arguments to this effect, not to be mis-
taken nor misunderstood.
  What  then is the system of treatment  demanded to
counteract a diseased action, which thickens delicate and
important membranes  by the deposite of coagulable
lymph upon  their  surfaces,  thereby  destroying their
functions; and at the same time altering the  structures
of such indispensable organs  as  the brain, spinal mar-
row and liver; and  by its rapid and destructive inflam-
mation, causing the death of the  mucous  membrane of
the stomach in a few days ?
  Can there be but one proper mode of managing  such a
disease?   Certainly not.   And that mode  consists in the
active employment of the means best calculated to allay
nervous erethism;  to arrest a destructive flow of blood
upon, or sanguineous congestion of important organs;
to prevent the secretion and deposit of coagulable" lymph
upon certain membranes, and  to reduce the force  and in-
flammatory power of the  general system.   These indi-
cations should be promptly and forcibly met by the best
means in our power, for the expectant practice in this 
53
disease either destroys the health of the patient for ever.
or is certain death, as it is in every active, violent dis-
ease of highly inflammatory character.
   Now,  what are  the  means best  calculated to effect
the objects desired ?  I know of none so likely to  re-
spond to our desires as the lancet, calomel, opium, or
its preparations, counter-irritants, saline purgatives, and
stimulating enemata.
   The action of the first reduces the general strength as
much  in  ten minutes as one month's starvation  by diet
would do: and it not only arrests the force of the general
circulation, but reduces at  once the whole system, ope-
rating as forcibly upon the excited condition of the ner-
vous as  the sanguineous system, and is, therefore, indis-
pensably necessary.  The second action  most desirable
to bring about, is that of mercury, which acts favourably
in all  its many important  influences.   Its sedative pro-
perty tends to allay the excited condition of the  system,
and its purgative to reduce its force; but above all is it
useful in this disease by the invaluable property it pos-
sesses of arresting the deposit of Coagulable lymph in
the tissues, and even correcting a disposition to  this by
the reduction of inflammatory action, and, therefore, the
direct and important bearing of this remedy upon  the
disease must be evident to every mind.   Counter-irrita-
tion is exceedingly useful in setting up an antagonizing
action by artificial means in a sound structure that  can
easily be allayed, but serving for the time to  attract the
circulation and existing irritation  and diseased action
going on in important  organs.  This indication  is best
subserved  by means of blisters, sinapisms,  and stimu-
lating enemata, which last, are some of the best means of 
54
relieving the brain.   Opium and its preparations serve a
good end in allaying nervous erethism  during  the stage
of excitement.   Thus, instead of acting as a  narcotic
or stimulant, when properly managed, it has a very bene-
ficial sedative effect upon the nervous system, and by this
action assists the other means employed for allaying ir-
ritation or  abnormal action, and at  the same  time, re-
lieves materially the sanguineous congestion of the brain,
spinal-marrow,  and  probably other organs.  Who can
doubt for a moment that nervous  excitement causes an
increased flow of blood to a part?   A very familiar and
convincing example of this action is  observed in the
suffusion of the face in  blushing, wherein the  flow of
blood to the part is doubtless caused  through nervous
excitement: witness also the violently increased action
of the heart under sudden and strong excitement of the
nervous  system.  Therefore, the  peculiar influence of
this  remedy is  demanded by the disturbed condition of
the economy, and acts in  unison with  the  means pre-
viously considered.
  It is only in this manner, and by a sound train of rea-
soning, that a useful and philosophic practice can be fixed
upon in any disease.   And the physician who  does not
examine  thus critically into the nature of disease and
acquire a positive knowledge of the precise character of
the altered  action and its ravages  upon the system, and
then apply such remedial  agents as will  bear the test of a
sound, deliberate criticism; walks in the dark, and trusts
to fortune, and not to medical science to lead him through
this mental erebus.   Having examined into the curative
action of the remedies employed, it is now necessary to
consider their immediate application. 
                          55
  If  the  patient  be  seen  during  the cold  stage  of
the disease,  which  lasts  for six or  eight  hours, ap-
ply a large blister,  covering the epigastric and right*
hypochondriacal  regions:  this  soon   allays vomiting.
Then give one scruple of calomel with  a  fourth or half
grain of sulphate of morphia, being governed entirely  by
the extent of nervous excitement. In the earliest stages
of the disease an emetic of ipecacuanha or chloride of
sodium with warm water may be given, and I have oc-
casionally employed it with advantage,  but not as a ge-
neral rule: still there can be no objection to the practice,
since the nausea and vomiting are frequently more easily
allayed after  it, and  it has a tendency to increase the
circulation upon the surface of the body.
   As soon as the fever or stage of febrile excitement is
fully established, strike boldly with the lancet; for this is
the sheet anchor of our hopes  of cure in this disease.
Bleed ad deliquium  animi—the amount of blood should
not be regarded in the least: let it flow until the fever
breaks, and the skin upon  the  forehead becomes moist.
This is a golden rule, and when properly followed, leads
almost certainly to  a cure.  I, therefore, bleed largely,
and even close the vein between my  fingers when the
patient is getting faint, (which is often the case after the
loss of but few ounces of blood) and give a  mouthful of
cold water—this passes off in a few moments, the head
still throbbing, and skin  hot and dry.  Then let the vein
spring, and the loss of a very large amount of blood is
borne, until after a time  all pain leaves the  head, back,
and limbs.   The skin becomes  moist,  the arm is bound
up, and the  patient  enjoys a refreshing  sleep, the first
o-enerally for forty-eight  hours.   The calomel is followed
six or eight hours after by an ounce of sulphate of mag- 
                          56
 nesia, which generally succeeds in opening the bowels
 freely;  if not, it should be repeated.  Dress  the  blister
-with mercurial ointment, in order to bring the system
 under the  influence of mercury, and a mild degree  of
ptyalism should be continued for about seventy-two hours
from  the  commencement of the attack,  during  which
time not a mouthful of any thing should be  taken  into
the stomach unless the vomiting continue.   In this case,
from  a quarter to  half a drop  of creasote dissolved  in
ether or acetic acid should  be given every hour until
it ceases, combining it with very small doses of morphia,
if the excitement of the  nervous  system require  it, but
not without.
  If the bowels be not opened  daily, they  should  be in-
jected with an  enema of castor  oil two  ounces,  tur-
pentine  four ounces, and sufficient gum water or other
vehicle to fill well the large  intestine.  This enema should
be given once or twice a day; in cases where the vomit-
ing continues, and there is  the least approach to dulness
of the intellect or coma.
  Iced water should be kept constantly applied to the
head, and ice or iced water kept in the mouth to allay
thirst, but should not  be swallowed;  for it is all impor-
tant to  keep the stomach  perfectly quiescent.  Where
the skin becomes hot and dry, it should be sponged with
cold water.  Sinapisms or some other irritant should be
applied  along  the  spine to relieve the pain in the small
of the back, which is the most severe  and persistent the
patient feels.
  It is sometimes the case that after the lapse of twenty-
four or forty-eight hours or more, the skin becomes hot
and dry, violent pain  in small of back, with throbbing 
                         57
pain in the head and  disposition to coma.  Where this
is the case, bleed again.  I am satisfied in my own mind
that I have saved life  by bleeding a second time in those
cases where there was a return of  the febrile symptoms.
Although this necessity does not arise in more than one
case in  two hundred, or at least  in one hundred; yet
where it  does appear, it is important not to neglect it.
When this system of  treatment is carried out rigorously,
the patient generally, on the fourth day, but almost uni-
versally on the fifth, is free from all fever, and has not a
bad symptom left, and desires something to eat; and if he
be moderately indulged with a little gruel of tapioca or
some such innocent diet, sweetened, spiced, and seasoned
with wine, he will improve very  rapidly: at the same
time, that is, from the fourth or fifth day, he should be
allowed to drink weak brandy and water—this is one of
the best stimulants that can  be employed—but he should
be  stimulated gradually: and  from this time no other
medicine will be required than small doses of extract of
colocynth or taraxicum  and  blue mass.  Where the
nervous system is much disturbed, small doses of strychnia
can be added with advantage, followed  ocasionally by a
Seidlitz powder, merely sufficient to correct the tendency
to constipation which exists for some time during reco-
very.
   After  the seventh day the convalescent can begin to
walk  about, yet  recovery  is  very slow; and  if the
patient remain in the region of the fever, he is very lia-
ble to a second or third attack: indeed if he  be kept in
the district of country where the fever was contracted,
he is more liable to a subsequent attack from the debili-
ty he is  then labouring  under, than he was  originally. 
                         58
 In the past summer in the gulf of Mexico, I  saw more
 than two hundred such cases.
   I am fully aware  of the great weight of authority
 against this view of the subject, and whilst I speak with
 all deference, yet  modesty should never have  the effect
 of hiding  truth; and  I am therefore compelled to give
 facts as they occurred, confident they can  injure no one,
 and often have the good effect of preventing exceptions
 being established as the rule.  In making the above state-
 ment, I am not governed by hear-say evidence, but posi-
 tively by my own observation: these men  I treated my-
 self, in both attacks of the fever;  saw them convalesce,
 as well as  they could, whilst kept in  the  same climate,
 and exposed  to  the  exciting cause  of  the   disease;
 watched them  in  the  performance of their duties, for
 days, weeks, and even months;  and then witnessed them
 again distinctly attacked by the fever a second  time, and
 from which some of them died; therefore it is a matter
 upon which I am perfectly convinced.  And from which
 I infer, that it would be exceedingly dangerous to advise
 those who are acclimated, or who have suffered previously
 from yellow fever, to  remain within the boundaries of
 its influence during its  epidemic reign, from the supposi-
 tion that they are beyond the grasp of its power.
  As regards more uncertain evidence of this fact, I can
 state that  I have often been  told by those labouring
 under this fever, that they had suffered from it on pre-
 vious occasions; and although  this is no proof; yet it is
 such as has been frequently taken in support of the im-
possibility of such an occurrence.   But I can bring for-
ward strong and positive evidence in support of the fact
herein mentioned, in cases I did not  witness  with my 
                         59
own eyes;  yet are  they beyond all doubt.  The follow-
ing is an extract from the letter of a friend, Win. H. All-
mand, Esq.,  secretary to Commodore  Perry,  whom I
treated for a severe and protracted attack of yellow fe-
ver in July last, from which he recovered, and was after-
wards engaged in very laborious duties, and continued free
from disease for months.  He now writes me to the follow-
ing effect, without knowing in the least that he has touched
upon a moot  point; but simply states a fact, viz:—
                            Vera Cruz, February 19th, 1848.
   " In the latter part of November, the  Commodore got
up an expedition for the ports to the eastward, and em-
barking in  the  'Mississippi,' took  also with  him the
' Scorpion and Water-witch.'  Unfortunately, however,
I had not been seventy-two hours on board before I was
again taken with the fever."
   It may be said this was, probably, not Yellow Fever;
but, in explanation, I  can state that  the Mississippi re-
joined the Gulf Squadron in the latter part of  October,
having left it in the early part of August previously, and
that after her return, she lost no less than four officers with
black vomit, showing  that she not only  had the Yellow
Fever on board, but had  it severely.
   The following is  from a friend who knows the disease
as well as one out of the profession can, from having
been raised where it is endemic, and has both suffered
from, and seen a great deal of it.  I  will, therefore, give
an extract from  the letter of  Lieut. J. R. Mitchell, U. S.
Navy.
   "I had an  attack of yellow fever in Charleston, (S. C.)
in the memorable summer of 1817, when  it raged with
the greatest virulence." "I had a second attack in  1821, 
60
in the small town of Jackson, (Alabama) where the fever
prevailed as an epidemic in its worst  forms.  My case
was for a time regarded as hopeless."  "In the summer
of 1822,1 had another, (the third) attack  in Pensacola,
where the disease of a most malignant type prevailed, and
I distinctly remember that  this attack  was quite, if not
more violent than the  generality of those cases which
proved fatal."
  The extract  below, is from the letter of Dr. T. M.
Potter, U. S. Navy—a gentleman  who has had  ample
opportunities of acquiring knowledge of the disease, and
his convictions  from actual observation and experience
upon this question are expressed in the following  terms:
        "U. S. Navy Hospital, near Portsmouth, March 25th, 1848."
  " I can also agree with you fully in the frequent recur-
rence of the disease after the patients were considered
sufficiently restored for duty."
  Nor are previous attacks of long standing any immu-
nity from  this disease, and  it is very probable  that the
escape which permanent residents make where this disease
is endemic, arises much more from the great care they
constantly take in avoiding the predisposing and exciting
causes, than from any protective influence arising from
acclimation. This perhaps gives them some better chance
of escape, but it does not protect them  from the disease.
And, beyond all  doubt, the  cause of strangers suffering
so much more, is from recklessness in  disregarding the
necessary avoidance of every thing that predisposes the
system to the disease.  Therefore, it is absolutely neces-
sary to safety and rapid convalescence to remove the
person at once  to a high, or perfectly dry, healthy, and
cool district of country; or if it be on ship-board, they 
61
should stand to seaward beyond the influence of breezes
from shore.   The  convalescent should  live well, and I
know of no drink during recovery from this fever equal
to good porter.  Exercise should be taken moderately; for
muscular debility, particularly in  the lower extremities,
continues for a long  time, and seems rather to increase
than diminish during the first few weeks of convalescence.
Vertigo, pain in the head, lumbar, and right hypochon-
driacal regions, with general debility and alternate diar-
rhea and constipation last for many months, with frequent
attacks of rheumatism; if the patient have  suffered at
all from this disease previously. Palpitation of the heart
is a very common sequence of yellow fever, arising from
the deranged condition of  the nervous centres..
   In the second  case, where the patient is seen for the
first  time on the fifth or sixth day, great care, and good
judgment are  required to fix upon the proper mode of
treatment.   If the system will bear the use of the lancet,
 use it, even though but few ounces of blood be  drawn,
 for the relief to the system is great. But there are cases
 where it cannot be thought of, nor even topical bleeding.
 Still where this can be supported, cups should be  applied
 to nape of neck, and in the  region of stomach and liver.
    The general condition of these patients is found to be
 oppression of the system,  with skin hot and dry, slightly
 tinged with yellow,  and  the sclerotica of the same hue,
 tongue dark brown in centre, edges and tip like raw beef,
 the whole mouth dry, with  the gums and mucous mem-
 brane of mouth and  throat occasionally bleeding.  There
 is listlessness or coma, and frequent vomiting of glary or
 greasy-looking matter or black vomit, and retention of
  urine.
    The  treatment of these cases should  be prompt, and 
                         62
to the purpose, but mistakes should be carefully avoided
in this stage of the disease, as they are dangerous. Where
general or topical bleeding is admissible, it should be
employed; every means should be  used to bring the sys-
tem at once under the effects  of mercury; counter irri-
tation should be employed by  means of rapid vesication
over the region of the stomach and liver, dressed with
mercurial ointment.  The colon should be filled with the
stimulating enema already mentioned three or four times
every twenty-four hours, and where the bowels are con-
stipated, croton oil, given either in tincture or pill  form,
to keep them gently  moved.   Iced water should be  ap-
plied constantly to the head, and the surface of the body
sponged with cold water or an evaporating lotion.   Ice
may be  held in the  mouth, and from half a  drop to a
drop of creasote in solution given every hour with brandy
and water.
   These are invaluable remedies at this stage of the di-
sease, for the system demands stimulation to  enable it
to react, and  the  creasote arrests vomiting, stimulates
the mucous membrane, and puts a stop to, and corrects
the advancing disorganization or mortification of this
organ.   The nitro-muriatic bath or sponging is useful
in these advanced cases with great oppression of brain;
or the application of  sinapisms to lower extremities.  But
the reductive means  should be changed in such cases as
in the  former, precisely at the right  time, and the sup-
porting or stimulative substituted.
  This is a nice point, of which too few seem fully aware.
Yet much of the success of treatment in  all  fevers  de-
pends upon it;  for if one continue the reduction of  the
vital force of the system, the fever that  he has tried in 
63
   vain to subdue, still continues, and the greater his efforts
   to allay this stage of fever and abnormal excitement, the
   more it appears to gather force, and the  patient sinks
   under it.
      But what is the real state of the case?   He has pro-
   ceeded too far, and has overlooked the difficult, but all-im-
   portant points of sthenia and asthenia (for the philosophy
   and usefulness of which we are indebted to Dr. Brown,)
   or when to arrest his measures from the reduction of the
   fever, has continued them, and now has  a nervous fever,
   or excitement set up  in the  system from very debility
,  and  want of stimulus.  A fever  and increased  heat of
   skin and quickness of  pulse, which to endeavour to sub-
   due by depressing or  depleting  means  involves certain
   destruction to the patient.  Indeed, it is a bad habit which
   many fall into, that of excessive medication of their pa-
   tients, a constant disposition to stuff them with remedies
   when the absence of all remedies is the only one required
   to restore the patient  to health—a choice their  medical
   guardians seem to  deny them,—losing  sight entirely of
   the "vis medicatrix naturae," for certainly there is  as
   much skill and judgment  required to  know when  not
   to administer medicine, as  when  to give it.  Yet do I
   think nothing  more  admirable  than bold and  active
   treatment wherever it  is required; and in yellow fever
   we have a disease with these requirements, a  disease
   in which the safety of the patient demands the  boldest
   and  most prompt action, an  affection  wherein hesita-
   tion  and weak  measures are almost certain death, or
   worse;  for who can tell the  melancholy changes  pro-
   duced upon the important organs involved in this active
   and  violent  disease, by a weak,  dilatory, and negative 
                         64
course; when all  is left to nature, and that nature for
the time run mad, and thus allowed  to  tear, maltreat,
and destroy itself, whilst its legitimate guardian, medi-
cine!  stands idly  by with arms folded, wondering what
will come next.  Better far strike into the heroically an-
tiphlogistic course herein recommended, and as I appre-
hend,  the only true course of treatment,  the  result of
which, in the late epidemic, which was remarkable for
its fatally malignant character in many localities, as well
as that of 1841  and '42, was sufficiently successful  to
preclude the remotest idea of a change of views or treat-
ment, particularly after having had the advantage of ob-  ,
serving the results of various modes of treatment in
Africa in 1844 and '45, and in the West Indies in 1846,
and the two epidemics heretofore mentioned.
  As  a few statistics  may not  be  deemed irrelevant, I
will refer to instances to be found  in the  official reports
and journals at the Navy Department.
  In the early part of the autumn of 1841, the U. S. Brig
Jefferson arrived  at Indian Key, Florida, having  sailed
from Mobile with the yellow fever on board and without
a medical officer.   On  her passage she lost some of her
crew,  who died with black vomit; and on her arrival at
the Key the sick were sent to the Hospital in every stage
of the disease; some of them being moribund, and others
who had been labouring under the disease for many days
died;  but I think there were  none lost who  had  been
landed within the  first three days of the attack.
  A few days after this, the U. S. Schooner Otsego ar-
rived  at the Key, from the  west coast of  Florida, which
she left two days  previously.  On her passage, Doctor
McKinley,  her only medical officer, and one of the crew, 
65
(they being the two first taken sick,) died on the seventh
day of the attack, having thrown black vomit from the
stomach during the latter part of the disease.  These two
bodies were buried, and every officer and man in her were
taken to the  Hospital  with the fever.  They all in due
time recovered, not one death having occurred after lea-
ving the vessel.  It was absolutely necessary for the ves-
sel to return  to her station to relieve an expedition in
canoes; and after having been perfectly cleansed, she re-
turned to the west coast with an entire new crew, officers
and men, both having volunteered for the duty: but in a
short time again returned, to land all hands, down with
the fever.  But warned  by the melancholy fate of the pre-
vious crew, the moment the disease made its appearance,
she sailed and arrived  two days after  at Indian  Key,
where fortunately they all recovered.  Some of the expe-
dition which they relieved died with black vomit upon the
coast, and three died at the hospital after landing, having
been sick several days.
  In the epidemic of last year, at the city of Tabasco,
where  it first appeared, we had considerably more than
three hundred  cases, but fortunately  had not one death
to report from  the fever.  And on board the U. States
Steamer, Mississippi, during the same summer, more than
four  hundred  cases of the fever occurred during the
months of July and August, whilst I was attached to her,
during which  time the only deaths that occurred on board
were Frederick Feihl, musician, and one seaman, the cox-
swain of the Commodore's barge, both of whom threw up
black vomit.
  After this ship left the  station, the late Dr. Howard
Smith and myself took charge of the naval Hospital  on
       5 
66
  the Island of Salmadina, where I think we treated over
  four hundred cases, and the following officers and men
  died of those received within the first forty-eight hours,
  viz: Dr. Kearney, Fleet surgeon, and Lieut commanding
  Chauncey, died on the fourth day, of apoplexy, induced by
  the fever, to  which they were predisposed; Lieutenant
  Chauncey having suffered previously from disease of the
  brain.   Dr. Howard Smith  died on the seventh day; and
  Richard Bates, master  of  arms, of the U.  S. Steamer
  Scorpion, over 70 years of age, died on the seventh day,
  also throwing up black vomit.  The following were re-
  ceived  from the fourth to the seventh day, and died with
  black vomit on the seventh  day: Dr. Bates, U. S. Navy;
  James  E. Ringrose, marine, aatat. 30; Francis Muscaro,
 musician, setat.  24; John Richardson, marine, astat. 30;
 George Burton, marine, setat. 55; Sergt. McDonald, ma-
 rine, astat. 57, and Sergt. Henry Aubrey, marine, aetat. 30.
 The two last were received  on the seventh day, and died
 in a few hours after, and James Carrigan, marine, aetat.
 28, died on the seventh day also.  Francisco Guido, mu-
 sician, setat. 40, died  on the fourteenth day with black
 vomit.
   Owing to the death or sickness of nearly all the medi-
 cal officers on the station, medical aid was not always at
 hand.   Thus, the  result of the treatment  as applied to
 the disease in the  several times heretofore related, was
 the loss of half per cent., in those received in the early
 stages of the attack; and in consequence  I have been
 asked by members of the profession, if they were  all re-
 ally and doubtlessly cases of yellow fever?   I can consci-
entiously say they were, beyond the least doubt.  As the
symptoms and march of the disease up to a certain period 
67
were precisely the same in those who recovered as they
were in those who died.  Nor were the fatal cases always
those from which the symptoms would most strongly and
decidedly have indicated yellow fever to the minds of those
who would have been stubborn skeptics, and determined
to disbelieve, until black vomit and death occurred, and
then yielding an unwilling consent; but on  the contrary
the whole march of the disease in some fatal cases, was
of the mildest character: whilst many of those who reco-
vered, were of the strongest and most marked character.
What places the matter beyond doubt, is, that in almost
an* fatal cases, death occurred on the seventh day, accom-
panied with the pathognomonic black vomit, and the post
mortem examinations always furnished evidence  of  an
identical cause of death.  If the fatality had been fifty
per cent., I would have given it; but since  it was but a
half per cent, it is  impossible to make it either more or
less, and must be given as it occurred whether the result-
ing mortality be considered numerous or otherwise.
   I have  also been asked if those attacked were not
merely ailing in most cases, or if they were really sick
enough to goto bed?  I will allow  others who were pre-
sent and observing the sick to answer this question. To
explain unanswerably, that  my imagination and indivi-
dual impressions did not cause me to consider those ab-
solutely sick who were  merely indisposed, I therefore
insert  the following accounts of it by others, to  show
the nature of the invading approach of the disease as ob-
served by them.
   The following extracts are from the letter of Lieut.
Simon F. Blunt, U. S. N., Executive Officer of the U. S.
Steamer Mississippi, in the  Gulf of Mexico, at the time 
68
and place to which his description of the yellow fever on
board this ship refers:
                    Washington, D. C, March 20, 1848.
   "I am sure that if the medical gentlemen of whom you
speak, could have witnessed the appalling scenes which
occurred on board the Mississippi, under our observation,
they would have no hesitation in pronouncing the disease
that prevailed  there, of the severest nature.   The cases
were, many of them, of the utmost vigour.  Men strong
of constitution and powerful of frame, were suddenly and
fatally prostrated.  Parker died of black vomit—Barbour
—Brown—Pons, and many others whose  names I do not
now remember were, as plain as colour and substance could
demonstrate, victims  to the yellow fever—black vomit—
or whatever other name characterizes the disease.
  "At least three hundred others were  prostrated as  by
a single blow, to  utter helplessness and the most immi-
nent danger.  The whole crew were so far disabled, that
when the determination to quit Anton Lizardo was finally
taken, I could not find more than fifteen of the ship's crew
to hoist in coal.   The extent and severity of the disease
for many days previous was such that all except the most
necessary duties had  to be suspended, in consequence of
the want of men to perform them.  The vomiting of the
sick, who could not  be removed from the ship, was  so
constant and extensive, that several men  had to be sta-
tioned to  keep the decks clear.  The boats were daily
sent to the hospital loaded with sick, until the entire num-
ber of souls on board amounted to not more  than one
seventh of the ship's complement.   There was scarcely a
man or  officer  who  escaped, and I can  truly say, there
was not  a well human being on board the ship for many days,
during this dreadful sickness." 
                           69
  The deaths by yellow fever, spoken of in the foregoing
letter, occurred at the time that universal sickness of the
same character, was prevailing at the City of Tabasco,
heretofore mentioned; and  I refer to it here, in order to
prove the nature of the fever at that place.
  The following extract is from the letter of Dr. T. M.
Potter, U. S. Navy:
                "U. S. Naval Hospital, near Portsmouth, March 25, 1848."
  "The cases of yellow fever which occurred in the  Gulf
Squadron were generally of a severe character, and those
affected with it, whom I saw under your care in the Hos-
pital at  Salmadina, some of whom  were sent from the
ship to which I was attached, were not only sick enough
to be put to bed, but were generally very ill, requiring, in
my opinion, prompt and immediate attention."
  I will  conclude this paper with a synopsis of the  Pa-
thology,  Symptoms and Treatment of this disease.
  Symptoms—Rigor; fever; injected eyes; pain in head,
small of  back and lower extremities; tenderness of epi-
gastrium; emesis and black vomit.
  Treatment—Bleeding; purgation;  ptyalism,  and coun-
ter-irritation.
  Pathology—Thickening of the membranes of brain and
spinal marrow, and  hardening of their substances; almost
cartilaginous firmness of liver, with discoloration; thick-
ening and  sphacelus of mucous-membrane of the  sto-
mach.    These changes  consequent upon  meningitis,
hepatitis and gastritis.
  There is no disease more entirely under the control of
medical treatment than yellow fever, nor is there any one
more imperatively demanding it; and I feel a firm  con-
viction of the truth and correctness of the principles herein
stated. 
^1 
LINDSAY & BLAKISTON'S MEDICAL CATALOGUE.
   MACKINTOSH'S  PRACTICE  OF  MEDICINE,
                          FOURTH AMERICAN EDITION.

                 THE  PRINCIPLES~OF  PATHOLOGY
                                      AND

       PRACTICE  OF   MEDICINE.
                   BY  JOHN MACKINTOSH, M. D. &c.
              FOURTH AMERICAN, FROM THE  LAST LONDON EDITION.

                           WITH NOTES AND  ADDITIONS.
               BY  SAMUEL GEORGE MORTON,  M.D.  &c.
                              I2T OITE VOLUME OCTAVO.
   " That this volume should have passed to a fourth edition in this country, is a strong proof of its
 popularity.   It is a most valuable epitome of medical practice, founded upon  the most approved
 pathology, the state of which at the present day, it very accurately represents. No better book can
 be purchased by the student than this, which ranks with the excellent works of Graves, Armstrong
 and Watson, to which in style  and arrangement it is closely allied.  The author was a man of great
 learning, indefatigable zeal, and extensive practice.  As a pathologist, he was able, warm and en-
 thusiastic.  He writes agreeably, with clearness and vigor, and his book bears the marks at once of
 deep thought, close and correct observation, ample experience and accurate knowledge of past and
 actual pathology.   It is one of the most useful Text books on the subject which it treats, extant in
 our language, and should be  in the hands of every student, and on the shelves of every Medical
 Library."—New York  Journal of Medical Science.
   " We regard this work as one of the best systems extant.  Its  first merit is that, unlike some
 others, it is not  overladen and smothered with facts and opinions drawn from a countless number of
 writers, ancient  and modern.  A second is the decisive tone in which the author expresses  himself
 —decisive, but not dogmatical, A third, we find in the intelligible simplicity of his style. A fourth,
 in the sound practical judgment evinced in the treatment which, in most cases, he recommends.  A
 fifth, in the natural and excellent arrangement of his subjects.
   " The editor has shown a mature judgment, and has enriched without disfiguring the text of our
 author."—Louisville Med. Journ.


          MEIG'S   VELPEAITS  MIDWIFERY,
                          THIRD AMERICAN EDITION.



                         TRANSLATED  WITH NOTES,
                     BY  CHARLES D. MEIGS, M.D.
              Professor of Midwifery in Jefferson Medical College, Philadelphia,.&c. &c.

         THIRD EDITION WITH NOTES  AND ADDITIONS,
                      BY WILLIAM  HARRIS,  M. D.
                             Lecturer on Midwifery, &c.  &c.
                        IN OITE  VOIUME  OCTAVO.
  " We have chosen this, because it appears to us to be one of the very best. It is a model for such
a work; the  several parts being duly connected, related, and managed with a beautiful simplicity,
and dexterity, like that used by the naturalist.  A sort of nomenclatural neatness and concisiveness
reigns throughout.   It is a book that no physician should be without."—N. A. Med. Journal.
  " The work before us  possesses particular  merits as an elementary treaties on Midwifery, and may
be profitably placed in the hands of Students. Whatever was originally deficient in it has been
supplied by the learning and  judgment of our countrymen who have translated and edited the work.
Among these additions one of the most elaborate and valuable is a chapter by Dr. Harris on Puer-
peral Fever."—Western Journal of Medicine and  Surgery.
  " The well known character  of this treatise renders an extended notice of it entirely unnecessary.
As an elementary work, Velpeau's has always  enjoyed a very high reputation, and has been used as
a Text book in a large proportion of our Medical  Colleges.  The present edition not only contains
the valuable notes of Professor Meigs, but is also enriched by others from the able pen of Dr. Harris."
                                                      N. Y. Journal  of Medicine. 
               LINDSAY & BLAKISTON'S MEDICAL CATALOGUE.


             THE  FATHERS  OF  MEDICINE.


       THE   WRITINGS   OF  HIPPOCRATES  AND  GALEN,

            ElPMOTimiSElB  AHJD EEEJBEffiEIB HUB® EHfSWEBI,

                    BY JOHN  REDMAN  COXE,  M.D.
                  Formerly Professor in tbe University at Pennsylvania, &c. &c.

                       IN ONE HANDSOME OCTAVO VOLUME.

  PUBLISHERS'  NOTICE.—Dr. Coxe, having translated the writings of these fathers  in Medi-
cine, has epitomised them in such a way as he deemed  most expedient, in order to afford the Pro-
fession a brief exposition of their contents; some of the Treatises are given in full, most of them,
however, would be considered superfluous, and are far too voluminous for the perusal of those mem-
bers of the Profession who are engaged in its active duties.  There are, probably, few physicians who
would not desire to trace an outline of  the writings of  two men who have always held such high
rank, of whom so much is said, both in books, in conversation and in every School of Medicine.
  Of the Treatises ascribed to  " Hippocrates,"  but few have ever been given in an English trans-
lation.  Of those of " Galen," none have appeared in that language, and of both it  may be said that
but few copies are to be found in  either public  or private libraries in this country, in either Greek
or Latin, although so many editions have been given to the European  world since  the discovery of
printing.
  " This work, as its title indicates, is an epitome of the writings of the two great ancient masters
of our art—being the first American or  even English translation of the works of Hippocrates and
Galen, which has been presented to the public.  The character, and known ability  and learning of
Dr. Coxe, is the best guarantee that he has well and faithfully discharged his task of translation and
epitomising,  while the publishers have done full justice to  the  typography and general mechanical
arrangement. The names of Hippocrates and Galen are  as familiar as household words to every
medical man, while it is to be regretted that their writings  have been so little, if at all read. An op-
portunity is now offered to all such as desire  it, (and who  is there  that does not) of becoming per-
sonally acquainted with those great men of antiquity."—St. Louis Medical and Surgical Journal
  Persons at a distance can be supplied by mail.


     THE PRINCIPLES  OF PATHOLOGICAL  ANATOMY,
                                   ADAPTED TO
FORBES, TWEEDIE, CONOLLY, AND DUNGLISON'S CYCLOPEDIA OF PRACTICAL
                    MEDICINE AND ANDRAL'S ELEMENTS,

       Illustrated by Two  Hundred and Sixty Beautifully Colored Figures.

                       BY   J.  HOPE,  M. D., F.  R. S.
                          Author of the Diseases of the  Heart, &c
                                    EDITED BT
                           L. M. LAWSON,  M. D.
            Professor of General and Pathological Anatomy in the Transylvania University.
  "The work before us, the last we believe published by the author, is a welcome and a valuable
accession to  the works on Pathology which we already possess.  Dr. Hope seems from  this speci-
men to have had  clear conceptions of the real objects and advantages of Pathological Science to the
foung practitioner.   He describes and represents the more obvious, and the more  striking changes
wrought in the system  by disease.  He does not consume his own, and the valuable time of the
student, in writing long chapters on the morbid alterations of insignificant crypta, or mucous glands,
whose very existence is alone revealed to a powerful microscope, but limits his descriptions to those
sensible, obvious and appreciable changes which result from diseased action, and hence the great
value of thiB work to the young  physician who is desirous to learn so much  of pathology, as will
enable him to institute a rational and sound system of Practice.—New Orleans Medical Journal.
  The execution of the work throughout does in fact great credit to its editors as well as publishers,
and we trust that their very commendable enterprise may be rewarded by a ready sale of the cor-
rect and beautiful, and, at the  same time, cheap edition  they have presented to  the profession of
the very valuable treatise of Dr. Hope."—American Journal of the Medical Sciences. 
NANKING'S  HALF-YEARLY   ABSTRACT
OF THE
        MEDICAL    SCIENCES.
Price  only  $ 1  50 per year, 75 cents per Number.
              LINDSAY  & BLAKISTON,
       N. W.  corner of Fourth  and Chesnut Streets, Philadelphia,

                          IP Iff IBM 8IH
          THE HALF-YEARLY ABSTRACT
                               OF THE

      MEDICAL  SCIENCES:
                               BEING

A Practical and Analytical Digest  of the Contents of the Principal British and
   Continental Medical Works Published during thep receding six Months.
                            TOGETHER WITH
A SERIES OF CRITICAL REPORTS ON THE PROGRESS OF MEDICINE AND THE
          COLLATERAL SCIENCES DURING THE SAME PERIOD.
                              EDITED BY
          W.  H.  RANKING,  M.D, Cantab,
               PHYSICIAN TO THE SUFFOLK GENERAL HOSPITAL.
                              ASSISTED BY
      W. A GUY, M. D., Professor of Medical Jurisprudence, King's College, London,
 GEORGE* DAY, M. D., Lecturer on Materia Medica at the Middlesex Hospital Medical Srhool,
         HENRY ANCELL, M. D., Lecturer on Medical Jurisprudence, &c, &c,
                          and W. KIRKES, M. D.
     Appnratu nobis opus est, et rebus exquieitis undique et collectia, arceBBitus, comportatis.—Cicero.

                       PUBLISHERS' NOTICE.
  This valuable work having been sufficiently long before the medical public to afford
ample time for them to judge of its merits, and having been so favorably received, it is un-
necessary to enter into any lengthened detail of them.  Its great object is to give  to the
physician who has not within his reach, or who cannot find time to  keep pace with the
rapid issues of the ever-teeming medical press, a work which will bring before him in a
cheap and condensed form, the most valuable and practical results arrived at by the most
learned men of the profession.  To such persons this work must prove peculiarly accepta-
ble inasmuch as it brings them up and places them en-courant with the knowledge of the
day with the greatest possible economy of time and money, and enables them to see at a glance
what works are worthy of farther perusal or purchase.  The value of works of a similar
character to this are weU known in  Europe, and their utility duly appreciated;  in this
country where their value is so much enhanced by the great extent of territory covered,
and the increased difficulties, except by means of  periodicals, of distributing knowledge,
as weU as by the aU engrossing avocations of the profession of our larger cities, such works
mu* necessarily continue to increase in circulation  as they become better known. 
     FLAN  OF BANKING'S ABSTRACT.
  The  plan upon which the work is conducted, is that of making extracts of the most valuable
matter  in each department of medicine from the chief works of interest to the profession, published
during  the preceding six months in France,  Germany, Italy, as well  as in the British  dominions
and America—thus opening a vast field of information, which has hitherto been a dead letter to the
great mass of the profession.  In order that this extensive and laborious undertaking may be accom-
plished  in the most unexceptional manner, the editor has placed certain of the departments of medi-
cal science—as anatomy and physiology, organic and pathological chemistry,  materia medica and
pharmacy, forensic and state medicine, &c.—under the superintendence of gentlemen respectively
eminent in their several departments.  To conclude with a series of reports on the  progress of the
several  branches of medicine, extending over the period of the preceding six months.
  The separate heads or classes under which the information will be distributed, are—
1. ANATOMY AND PHYSIOLOGY.
2. PRACTICAL MEDICINE, PATHOLOGY
     AND THERAPEUTICS.
3. PRACTICAL SURGERY.
4. OBSTETRIC MEDICINE.
5. PATHOLOGICAL CHEMISTRY.
6. MATERIA MEDICA AND  PHARMACY.
7. FORENSIC MEDICINE & TOXICOLOGY.
8. PUBLIC HYGIENE.
9. CRITICAL REPORTS.
  Each number will also contain a bibliographical record of British and Foreign Works published
in the previous six months, with Prices, &c, Tables of Mortality, and other statistical information.
  By this arrangement it is confidently expected that a work will be produced, such as, for extent
and importance of matter, and convenience of expense, has never before beenettempted, and it is
offered to the medical public under the firm impression that its advantages,  as forming in itself a
complete epitome of the medical sciences, will quickly be appreciated.

                            RECOMMENDATIONS.
From Prof. Horner, Dean of the Medical Faculty of the  University of Pennsylvania.
Messrs. Lindsay & Blakiston :                         Philadelphia, March 5th, 1847.
  Gentlemen,—I have looked with pleasure over No.  2, Vol.  ii, of the Half-Yearly Ab-
stract of the Medical Sciences as sent for my inspection.  It contains a valuable summary
of professional matters for the period a little antecedent to its publication, and if sustained
in its present  state, this  journal is, in my opinion, well worthy of encouragement and pa-
tronage.                        Very respectfully,                  W. E. HORNER.
   From Prof. Huston, Dean of the Jefferson Medical College of Philadelphia.
  Dr. Ranking's Half-Yearly Abstract of the Medical Sciences is a work deserving of the highest
commendation.  The selections from the medical journals are made with much care and
judgment, and constitute an excellent epitome of the recent observations and discoveries
of the day.  The Reports, too, on the various branches of the science which it contains,
evince great ability and impartiality, and add essentially to the value of the work.
                                      -----               R. M. HUSTON,  M.D.
      From Prof. Meigs, of the Jefferson Medical College of Philadelphia.
  Gentlemen,—I  think that you are engaged in an enterprise that will be very useful to
the medical profession; I mean the publication  of Ranking's Abstract of the Progress of the
Medical Sciences.  I hope that it may be generally read, and that the taste for inquiry and
careful observation may be every where encouraged by it.
  I am, very respectfully, Your obedient servant,                        C. D. MEIGS.

       From Prof Mutter, of the Jefferson  Medical College of Philadelphia.
Messrs. Lindsay &  Blakiston:
  Gentlemen,—It will afford me much pleasure to recommend to my class your edition
of "Ranking's Abstract."  It is a most excellent work, and must prove of great value to
the country physician especially, who rarely has access to the medical journals from which
the "abstracts" are taken.             Very truly yours,         THOS.  D. MUTTER.

                         TERMS OF PUBLICATION.
  Published in LONDON on the 1st of January  and 1st of July, and in PHILADELPHIA on
the 1st of February and 1st of August, of each year.
  Price SI .50 per annum, 75 Cents per Number.   Back Numbers or complete sets  furnished.
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                                  LINDSAY &  BLAKISTON, PUBLISHERS,
                              N. W. corner of Fourth and Chestnut Sts, Philadelphia 
  NOTICES  OF  BANKING'S  ABSTRACT.

From Dr. Charlton's Retrospective Address before the Provincial Medical Associ-
                                ation, at Sheffield.
  "The difficulty of obtaining a competent  knowledge of the current literature of the day,
which is so much felt by those  actively employed in the duties of our profession, and es-
pecially by that most important class, the general practitioner, will, we think, be greatly
diminished by the publication of a work containing a brief, but excellent summary of the
most recent researches.  Dr. Ranking's ' Half-Yearly Abstract of the Medical Sciences/ ol
which the  first volume has just appeared, possesses the peculiar advantage of presenting
admirable reports on each division of medical science from pens of individuals who have
specially devoted themselves to these various branches of professional pursuit."

                     From the Provincial Medical Journal.
  "The sifting which the journals and other medical works undergo, and the judicious se-
lection from their pages of points of practical interest, and of discoveries of importance in
collateral sciences, form an important part of the duty of the editor, and after a careful ex-
amination of Dr. Ranking's volumes, we  are bound to 6tate that the duty has been most
ably performed."
              From the Edinburgh Medical and Surgical Journal.
  " The work is well conceived, and executed with ability, and we doubt not will be usefal
to those who feel it their duty to keep up with the knowledge of the day."

                 From the  Boston Medical and Surgical Journal.
  Promptly, at the promised period, Messrs.  Lindsay & Blakiston, of Philadelphia, have
issued the first and second parts of the second volume of the Half-Yearly Abstract of the
Medical Sciences—extending from January to  December, 1846.   Nearly all the articles
are of sterling value, culled  from  the  most approved sources  in modem medical publi-
cations.   How a work of this kind can be afforded for ONE DOLLAR and FIFTY CENTS
A YEAR, is a  mystery that wholly belongs to  the craft of publishers.  Gentlemen desirous
of possessing a digest of current Medical literature, will be pleased with this excellent re-
print."
                          From the Medical Examiner.
  "This is a publication on a somewhat similar plan to Braithwaite's Retrospect, over
which it possesses advantages in the better arrangement and selection of its subjects, and
especially in containing condensed Reports on the various branches of Medical  Science
The Editor, Dr. Ranking, is an industrious contributor to the British Medical Journals, and
judging from his past performances is well qualified for the task he has undertaken,"
              From the New York Medical and Surgical Reporter.
  " This number fully sustains the high character of this work which the previous ones
have established. It certainly is the most practically useful periodical of the day, and one
which in point of interest and utility to the profession, has none to equal it.
  " It contains every discovery and improvement made  in all the departments of Medical
Science, and in all countries, up to the time of its publication, together with critical reports.
written by the ablest men in the profession; it gives an interesting abstract of the Medical
Journals  of all countries, and a record of all the works  on  medicine and the collateral
sciences that have been published since the former number was issued. This work should
be in the hands of every Physician who desires to keep  pace with the progress in his art" 
LINDSAY &  BLAKISTON'S MEDICAL CATALOGUE.
    THE  PRINCIPLES AND  PRACTICE  OF  DENTAL  SURGERY.
                         Third  Edition, greatly Enlarged,

 TOP 1  HTOIMMIHffS   AIMWMJL   MTOmkTOOTo
                      BY  CHAPIX A. HARRIS,  M.D., D.D.S.
Professor of Practical Dentistry and Dental Pathology in the Baltimore College of Dental Surgery;  Editor of the
                          Baltimore Journal of Dental Science, etc. etc.
                              IN ONE VOLUME, ROYAL 8VO.
  The present edition of this work has been considerably enlarged by the addition of a fourth part
on the Diseases of the Palatine Organs,  their Surgical and Mechanical Treatment, 4-c.  <fre.f
together with many additional illustrations.  The flattering manner in which the second edition  has
been received by the profession, together with its rapid sale, has warranted the author in sparing
no labour, and the publishers no expense in endeavouring to make it the most complete work of the
kind extant
  " The members of the profession, and students in particular, have long felt the necessity of a treatise
on Dentistry, in all its branches, medical, surgical and  mechanical, which should at once be com-
prehensive in its scope, practical in its detail, correct in its science and beautiful  in  typographical
execution.
  " Dr. Harris has proved himself so well qualified for this task, that it may be safely asserted that no
one volume in the English language contains an equal amount of correct and valuable  information
for the use of the student in dentistry.  There are manifested also in Dr. Harris's volume an origi-
nality of thought and an independence  of opinion equally calculated to elicit truth and to expose
error."—Journal of Dental Surgery.
  " As it now stands, it presents a more  complete and comprehensive treatise upon all the branches
of Dental Surgery, than is to be found in  the English, or, as far as our observation has extended, in
any other language."—Dental Intelligencer.
  '' This is the most complete treatise on Dentistry we have ever yet seen.  It comprises a history of
the art, from the most remote times, tracing it through all  its improvements.  The  plates which
accompany  it are admirably executed, and are so arranged in the volume, as to afford a  ready refer-
ence for the objects which they are designed to illustrate.   We beg  leave to recommend this inva-
luable work to each member of the faculty, as every way worthy of an attentive perusal."—Southern
Advertuer.
  " We have been much pleased in looking over (though cursorily) the above work.  We feel war-
ranted in saying, that it embodies more  practical information and less faults than any other work
on the subject in the English language; we would  consequently recommend its perusal in  the
most unqualified terms to the  medical profession generally and to the scientific Surgeon Dentist in
particular."—Southern Medical and Surgical Journal.
  " Dr. Harris, with a judgment as ripe as his views in pathology are sound, covers the whole ground,
past  and present, and thus secures a distinction for our country, while his undertaking  also confers
an honour upon himself."—Boston Med. and Surg. Journal.
  " The present edition of the above  work, enlarged and improved, as it has been by the author, may
be safely pronounced the most comprehensive, and at the same time the most concise treatise on
the subject  of Dental Surgery which has yet appeared in the English language.  It will be hailed
with pleasure and read with profit, by every one interested in the subject.   A glance at the plan of the
work, and its contents will serve to show  the wide field traversed  by the author.  This treatise  will
not only meet with a ready and extensive sale, but will become a standard work, for it furnishes the
basis of a sound and thorough practice."—(Saturday Courier.


     THE  SURGICAL  AND MECHANICAL  TREATMENT OF  THE TEETH,


            With one htmfcrrtr antf thfrtg nftte  Xllustratfotts.
                               BY JAMES ROBINSON,
                       Surgeon Dentist to the Metropolitan Hospital, &c. &c.
  '■ Besides being a complete Manual of Dental Surgery, it  contains much  valuable intormation  upon several
points which the medical student, and even the practitioner, is often too superficially informed upon."—Dublin
Medical Press.

ARTHUR'S MANUAL OF DISEASES OF THE   TEETH,
      Including a description of their Structure and Modes of Treatment, &c.
                               A SMALL  POCKET  VOLUME.
  " This is a good manual, and comprises all that is necessary for the general reader and practitioner of medicine
to know on the subject, and being written in  a plain and  perspicuous  style, without the unnecessary use of
technicalities, is adapted to readers of every class."—Med. Examiner. 
 
 
 
*"W . *»Trfp»n»wr
m
'^lllHl'r^irffeifl^1!1'1"'
sll Illi ill II !i I rrl! Ill
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