Vaccinia is by no means a variola mitigated by its passage from man to the cow, as has been pretended. It is an affection localised on the udder of the cow, and which scarcely produces in that animal any febrile disturbance; whilst the inoculation of variola is very often fatal to it, as Dr. Sunderland has proved by his experiments (I refer the reader for full information on all these questions to my great work, Monument à Jenner ou Histoire générale de la vaccine).

All eruptive fevers are characterised by a period of incubation, the duration of which is so much the longer, according as the poisoning has been more intense, and which is recognised by a general prostration, a feeling of lassitude, dull headache, pain in the loins, turbid urine, etc. The physician may at once prognosticate what will be the kind of eruptive fever with which he will have to deal, by the cerebroabdominal, catarrhal or throat symptoms. Thus, if it be a case of small-pox (variola), the cerebral and abdominal symptoms will be especially predominant. If it is scarlatina, there will be throat symptoms, or difficult deglutition. If, on the contrary, it is an attack of measles, there will be a development of catarrhal symptoms:-coryza, lachrymation, bronchial cough, and difficult respiration, with slightly sibilant râles.

During this period of the disease, the Seidlitz salt must be administered every morning to refresh the intestine, and arseniate of strychnine must be given, so that the system may possess the requisite power to evolve the virus, or cast it to the surface or on to the skin; for it is well understood that those are the most dangerous eruptions which do not come out. In such cases the fever is more intense, and the internal disorders more serious. Then, also, may be seen to supervene, meningitis, angina, and pleuro-pneumonia, without there may be internal eruption. It is not, then, the eruption which has been driven in, but that it has not been formed. It is observed, on the contrary, that the external eruption

coincides with an internal eruption, as in small-pox, in which pimples form in the mouth, pharynx, and the digestive and respiratory passages. Hence, another danger, which must also be foreseen.

Therefore, during the period of incubation of the eruptive fevers, the vital force must be incited by arseniate of strychnine

A granule every hour till the eruption appears.

If the fever, which is not long in appearing, is very intense, the temperature being 40° and 41°c., and the pulse 120, aconitine or veratrine must be added to the arseniate of strychnine

A granule of each, together, every half-hour until defervescence.

A relaxation then takes place. The skin becomes moist, the pulse slackens, the temperature falls to 39° or 38°c., and the eruption comes out without storm, agitation, or delirium, and without any trouble as regards respiration or digestion.

If delirium should supervene, digitaline must be given, like as in cases of nervous delirium :—

A granule every hour, until sedation.

Digitaline will assist in bringing about general relaxation, by causing diaphoresis and diuresis.

When once the eruption is developed, the physician must confine himself to hygienic measures, unless symptoms of absorption or septicemia should declare themselves.

In that case, regard must be paid to the remissions and paroxysms of fever, which indicate that the vitality is greatly depressed. Arseniate and hydroferrocyanate of quinine must then be given :

A granule of each, together, every half-hour, as long as the thermometer indicates variations in the animal temperature.

Quinine acts here as an excito-motor, and prevents internal congestions. It would be a grave error, and at the same

time an enormous danger, to wait giving the febrifuge until there is apyrexia. It would be a vain waiting, or rather, the patient would be left to perish. It is especially in eruptive fevers that expectation is dangerous, and most often mortal.

In eruptive fevers, it is a common opinion that an artificial incubation is required, by increasing the temperature of the apartment.

This is a very great mistake, since the evolution of the disease is thereby prevented. A moderate temperature is necessary, and defervescence should be accomplished by the alkaloids. At the Civil Hospital of Ghent, the wards are heated uniformly to 16° or 17°c., and this is found to answer well, since there are thus fewer complications. Thus, not only is there less bronchitis or pneumonia, but such are in general mild attacks, thanks to the air constantly renewed by a steam-engine. The ventilation takes place downward; that is to say, the descending or infected strata are rejected outwardly by the upper strata of pure air which the machine forces into the wards. Therefore, it is especially necessary to attend to the purity of the air.

The eruptive fevers or acute exanthemata are too well known for it to be needful to dwell upon them here. Besides, these fevers are not dangerous except by their complications : -smallpox, from entero-gastro-meningo-encephalitis; scarlatina, from angina gangrenosa; and measles, from bronchopneumonia. The physician should therefore be on his guard against these complications, and combat them on their first appearance, not by debilitants but by vital incitants. Formerly, it was not understood what it was to incite; it was usual to excite, in other words, to exhaust the vitality. Thus, when revulsive agents are employed, no strength is brought to the system; on the contrary, it is weakened. It is therefore necessary, before all, to attack the cause of the disease, and to guard against its effects. This is what dosimetry does, by the dominant and variable treatment.

SEPTICEMIA OR PUTRID INFECTION.

Septic fever, when caused by the re-absorption of putrid ichor, is observed after extensive wounds and operations, where the detritus of the tissues gives rise to an extremely penetrating virus, which exercises a deleterious action on the blood and organs. The effects, also, of this decomposition are very rapid.

The fever manifests itself by violent shiverings, alternating with a dry, harsh heat (pulse, 120; temperature, 40°—41°c.), and after two or three paroxysms, the patient can hardly be recognised, so much has he changed. His complexion becomes yellow, jaundiced; a proof that the liver is attacked. However, it is not the bile which has passed into the blood, but it is rather the ichorous matter which has decomposed the latter fluid; and the tissues having lost their cohesion, a general ecchymotic condition is induced. The patient has troubled dreams, and sometimes is delirious. Points of congestion form in succession in the lungs, the joints, the muscles, and the abdominal viscera: the kidneys, spleen, and liver, with surrounding oedema, and the formation of multiple abscesses, which take their rise from species of nuclei. The red and white globules of the blood combine to form their base.

Thus are produced, not what the ancients believed to be purulent metastases, or the conversion of the blood into pus, but genuine local, though insensible inflammations, which are, nevertheless, quite as real as idiopathic abscesses, all the characters of which they present.

These

These abscesses can be caused artificially by introducing into the vessels of an animal, crushed clots of blood. small particles, thrown into the circulatory torrent, and rounding themselves there like the pebbles of the sea, simulate the globules and obstruct the capillaries, which they rupture, and fix themselves in the surrounding cellular tissue.

In septicemia, the vitiated blood-globules act the part of emboli.

But before that, there is an essential alteration due to the introduction of the ichor.

It is this alteration which must be prevented, either by carrying away the ichor as soon as formed, by currents of water, or hindering its formation by antiseptic agents, such as carbolic acid, camphorated spirits of wine, solutions of permanganate of potash, salicylic acid, thymol, terebene, etc.

Among these antiseptic dressings, I would particularly notice those of lead, because there is thereby formed on the surface of the wound, a layer of black sulphuret, which prevents putrid decomposition, or the formation of carbonate of ammonia, which being absorbed, gives rise to the adynamia and ataxy which characterise septicemia.

Latterly, putrid fermentation has been attributed to the agency of small living corpuscles or organules, to which the names of vibriones, bacteria, microphytes, infusoria, etc., have been given. That these organules exist, there can be no doubt, for they are found in our blood, our humours, and even in our tissues, both as well in the physiological as in the pathological condition; and it is difficult to understand why they should produce fever in the latter state rather than in the former.

It is necessary, therefore, always to attend to the disturbance or alteration of vitality. As evidence of this, when the latter is restored, the fever ceases, even although some organic alteration may already have commenced. Thus, the typhus of the wounded may be combated like miasmatic typhus, and in a similar manner, that is, by the alkaloids.

For that purpose, it is wise to institute a preventive treatment. M. Chassagnac styled the administration of alcoholate of aconite, a few days before a serious operation, as "surgical training" (entraînement chirurgical).