If

glimpse of asthenia. But his active measures were rude: instead of inciting, he excited*; that is to say, to an irritation, he knew only but to oppose a fresh irritation. instead of the inflammatory medicaments of allopathy, he had had at his disposal the defervescent alkaloids, suffering humanity might have avoided great disasters.

Thus dosimetry acts, and there lies its power. For this reason it has been adopted from the first by all conscientious physicians, who do not share the views of that school which, preaching organicism exclusively, has diverged more and more from vitalism—the doctrine of Hippocrates.

What is life? Bichat defined it as "the resistance to death"; but this definition has been censured, as an attempt to define the unknown by the unknown. Yet, meanwhile,

this is all that can be said. When a place is besieged, and the enemy makes a breach in some part of its fortifications, its defenders do all they can to strengthen that point; behind the existing ramparts they raise others. Thus nature acts: she fortifies the points attacked by doubling and tripling the vital resistance. Broussais was therefore wrong in seeing everywhere cause for bleeding, even as Brown was equally mistaken in consuming the sources of life in the organism attacked.

Having said this much, I may now approach the subjectproper of my work.

* This distinction between vital incitation and excitation, although specious in appearance, and having the air of a paradox, is very important from a practical point of view. It is evident that when we excite, that is, irritate, the tissues or the organs, they become weakened. At the same time the sum total of the general vitality is diminished. So Brown and his disciples, in giving diffusible stimulants, were only augmenting adynamia. This is what Broussais has rightly reproached them with. But he was wrong, on his part, in seeing everywhere a sthenic condition. There is irritation, consequently, exaggerated expenditure of vital forces. The equilibrium of these latter must therefore be re-established, and thus the defence is proportioned to the attack. When these ideas shall be thoroughly comprehended, fevers and inflammations (in the sense which the organic school attaches to them) will cease.

DOSIMETRIC TREATMENT OF FEVERS.

A due amount of caloric is one of the manifestations of life. If this caloric diminishes, disease is indicated; should it disappear, there is death; and when it increases, it proves vital exhaustion. To continue my former comparison, in the latter case it may be compared to those fortified places which, in defending themselves with energy, exhaust their ammunition.

It is now known that animal caloric depends on the vasomotor nervous system. All those causes which have a tendency to interfere with or impede the action of the latter, produce fever.

But, among those causes, some are more depressing than others; there are even some which completely annihilate caloricity or the action of the vaso-motor nerves.

MIASMATIC ALGID FEVERS. PERNICIOUS

PALUDAL FEVERS.-ASIATIC CHOLERA.

Pernicious intermittent fever was named algid fever, because the cold stage is prolonged during the greater part of the attack.

It is a nervous paralysis, in which reaction cannot take place, or is insufficient.

The fever is said to be masked when it assumes the appearance of another disease, according to the organ or system organs in which it localises itself.

of

At the commencement of my medical career, in 1826, when I was house-surgeon at the Civil Hospital of Ghent, I had the opportunity of observing an epidemic of pernicious fever,. assuming many forms. This fever, of a paludal character, had been caused by the digging of a canal to the sea, through the ancient marshes. Of the sick who were brought to the Civil Hospital, some were unconscious, in a comatose or apoplectic condition, others were delirious, and others spat blood; there were some who presented symptoms of pleurisy, pneu

monia, etc., and these symptoms, when once the paroxysm of fever ceased, would disappear. The nature of the affection could only be diagnosed by the pulse and the temperature; indeed, the pulse was much accelerated and very feeble. In the period of reaction the animal heat rose to 41°c. Sulphate of quinine, given in time, prevented a second paroxysm, and saved the patients. All those died with whom this precaution had not been taken. The autopsy showed the organs to be congested with venous blood, but nowhere could be found any inflammatory products, either of exudation or suppuration.

Arseniate of quinine acts wonderfully in algid fevers, along with strychnine, aconitine, and veratrine:

A granule of each, every half-hour, as soon as the cold stage has passed off, that is to say when there is free absorption.

If these medicaments are given during the period of dry heat, the latter is shortened, and congestions prevented.

The algid state consists in a paralysis of the vaso-motor nerves, that is why strychnine, notably the arseniate, should be employed. The aconitine and veratrine act as defervescents, and the quinine as an antiperiodic. (Vide Manuel de la Fièrre.)

ASIATIC CHOLERA.

The algid fever of 1826 was the forerunner of the Asiatic or Indian cholera ; indeed, in 1832, the scourge reached us, after having traversed Russia, from east to west, halting successively at Moscow, St. Petersburg, and Warsaw, arriving at the Rhine by way of Breslau and Berlin. I notice this route in order to prove that cholera is a miasmatic affection, the germs of which scatter themselves over a wide area, and follow a determinate course, as has been observed in each epidemic.

The disease sometimes announces itself by certain precursory or premonitory symptoms, characterised by some abdominal derangement; at other times it breaks out suddenly

with violent cramps, and a considerable diminution of the peripheral temperature, to such an extent that the patient is chilled externally, whilst he burns inwardly.

To make a brief digression. I believe I shall interest my readers in here placing before them the account of a case of cholera as narrated by the naturalist, Victor Jacquemont. They will see how the medication employed to combat this terrible disease was of an inflammatory nature :—

"POONA, July, 1832.

"Soudine, my Hindu servant, aged twenty-five years, enjoying perfect health, and of regular habits, an abstainer from every kind of spirituous liquor, and almost entirely from animal food, was seized on Friday evening, July 5th, with colic, and very numerous and abundant alvine evacuations of whitish matters, followed at the end of an hour by vomitings. It was only at this moment I was informed of his illness.

"His attitude showed great prostration of strength; he complained of tenesmus, the pulse was very feeble, and the feet a little cold. The evacuations were repeated, upwards and downwards, more than ten times in an hour. Their character was the same it was a but slightly viscous though thick fluid, of a greyish white colour, without odour.

"The patient was put to bed and warmly covered; bottles of hot water were applied to his feet, and hot towels placed on his abdomen; 20 drops of ammonia, in a spoonful of water, were also administered. The patient swallowed this burning drug without complaint, but in about two minutes vomited it. Between the hours of seven and eleven in the evening, four other similar doses were administered, in the intervals of cessation of the natural vomiting, but not one was retained more than three minutes in the stomach. In one of these doses I mixed 20 drops of laudanum. He, however, rejected it as soon as swallowed.

"The natural heat withdrew rapidly from the extremities.

The feet were colder than the hands; the legs and also the arms became cold; the pulse could only be detected after the exertion of vomiting; the alvine evacuations became less frequent; the respiration was accelerated, and the body cooled gradually; but the patient complained of an inward heat, which burnt him and caused him to violently throw off his bed-coverings. He pulled off his clothes, and demanded to be left naked.

"These sudden and transient invasions of inward heat were only perceived by a temporary elevation of the heat of the body. At these times a cold and clammy sweat exuded from the forehead only, but the coldness of the legs was not affected by any accidental return of heat.

"The patient suffered from cramps in the thighs and spasms of the abdominal muscles, during the prevalence of the internal heat. The skin of the palms of the hands and of the soles of the feet became hard and rough; the nails were discoloured and blanched, the eyes began to get hollow, and to encircle themselves with smaller, deeper, and blacker interior arches, and with larger arches on a level with the superior borders of the maxillary bones, over the osseous crests of the inferior portions of the orbits; their movements lessened, and their brightness was dimmed.

"At midnight, I gave to the patient eight grains of calomel in a spoonful of sweetened aromatized water; but the vomitings which, without being increased by the remedy, were repeated at intervals of some minutes, expelled at least a great part. At one o'clock on Saturday morning, I gave another similar dose of calomel, with 20 drops of laudanum, but it was rejected in two minutes. He passed the remainder of the night without drinking anything, except a little sweetened water when he suffered from thirst, which only occurred during the sudden invasions of internal heat.

"On Saturday morning the pulse could not be detected, except at intervals, after the convulsive efforts of vomiting.