accurate manner, by William Brown, M. D., of Edinburgh, in a paper which may well be cited as a model for similar investigations, contained in vol. vii. of the "Annals of Medicine," for the year 1802, edited by Drs. Duncan, Sen. and Jun. Dr. Brown shows very clearly and conclusively that the powers of medical treatment in arresting the disease, or in shortening its duration, are, to say the least, very doubtful or very small.

Hildenbrand says: "In this disease, our treatment can only be of benefit in an indirect manner, that is, in concert with the salutary efforts of the vital powers. No method yet known, whether rational or empirical, can cure the contagious typhus, either in a direct or an indirect manner, nor even abridge its ordinary and natural course, which is about fourteen days."

[Dr. Stokes has expressed the same opinion, but more strongly. His words should be the ever-present monitor of those who have to do with this disease. "The treatment of fever," he says, "is reduced to a formula. We cannot cure fever. No man ever cured fever. It will often cure itself. If you keep the patient alive till the fourteenth, the eighteenth, or the twenty-first day, he will recover. We prevent his dying of exhaustion, by food, by the use of stimulants, by tonics. We save him from the effects of the secondary local complications by meeting them as early as they can be discovered. Thus, we seek to preserve the patient at the least expense to his constitution up to the time when, by natural laws, the disease will spontaneously subside."2

At Bellevue, during the eight years of typhus fever, the treatment varied considerably. General bleeding was not resorted to; emetics were sparingly used; active cathartics were not tried ; laxatives were used from first to last, but only pro re nata, not by formula. In the early periods of the epidemic, a mild mercurial course was tried by some of the physicians; others relied on ipecac, one grain every two hours, and the acetate of ammonia; covering the whole body with oil or simple cerate, was practised to some extent. But as early as the third year, most of the physicians fell into a very simple plan of treatment, and the fever wards were those to which the least medicine was sent. It is believed to be literally true, that hundreds of mild cases were treated without a single prescription for the apothecary.

Sponging with cold or tepid water when the skin was hot; the

1 Gross's Hildenbrand, p. 94.

2 [Lectures in Med. Times and Gaz., 1854.]

This book is the q
COOPER MEDICAL LO

free use of cold water as a drink; a good daily allowance of beeftea; and, more than all, a free circulation of fresh air, even in the cold weather of winter, constituted the whole of their treatment. But in cases of greater severity, while these means were always used, brandy was ordinarily depended on as a stimulant. When the pulse became frequent, and had lost much of its force, this stimulant was almost always given, and especially if the tongue was dry. It was urged, together with the beef-tea, just in proportion to the evidences of general depression of the vital powers. Instances occurred in which forty-eight ounces of brandy were given daily for several days in succession, with the most satisfactory results. The stimulant was not withheld in consequence of any complication. In more than one instance it was continued through the whole of a supervening pneumonia. It was not considered improper to give it, while leeches or cups were required for local complications. Camphor and carbonate of ammonia were used, or camphor alone, in the latter stages of severe cases. The bronchial symptoms, though almost always present, did not usually require. treatment; if they did, the local means were stimulating frictions, dry cups, and the oil silk jacket next the skin, covered with flannel. Pneumonia was treated in the same way. The head symptoms, when threatening, were treated with dry or wet cups, or leeches to the back of the neck or temples, moderate cold to the head, and blisters to the back of the neck. Camphor was found valuable in quieting the nervous restlessness and the occasional hiccough. Dover's powder, and sometimes small doses of sulphate of morphia, appeared to be useful at night in overcoming wakefulness and delirium. Among these curative agents, none was more valued by most of the physicians than fresh air. Even in winter, and in the coldest of the winter, the windows of the fever wards were to be kept open, at least a few inches, while coal and blankets were furnished to meet fully the wants of the patients. The general mortality from the beginning of the epidemic till the disease disappeared was not probably materially less than in similar epidemics elsewhere; yet one of the physicians had the satisfaction of seeing seventy-two of his patients, received from the first of October, 1851, to the first of February, 1852, recover, without a single death. This was after the greatest force of the epidemic had passed. From these details, it will be seen that the great principle of Dr. Stokes was wrought out and fully put in practice some years before it was formally published by its author.]

CHAPTER XI.

DEFINITION.

THIS disease, in the present state of our knowledge respecting it, may be defined in the following terms: Typhus Fever is an acute affection, occurring at all ages of life; attacking, at least in cities, somewhat more frequently persons who are recent than those who are old or permanent residents; often transmitted directly from one individual to another; very much more common in the British islands than anywhere else, although prevailing at times in other countries, generally in the form of circumscribed epidemics; often connected with the crowding of many persons into small, dark, and poorly-ventilated apartments, amidst filth and destitution; frequently sudden, but sometimes gradual in its access; attended at its commencement with chills, usually slight and in many instances repeated; then with morbid heat of the skin, in many cases very intense and pungent; with increased quickness, with softness and feebleness of the pulse; with accelerated respiration; in many cases with the physical signs of bronchitis and pulmonary congestion; with pain in the head, back, and limbs; dulness or perversion of the powers of the mind; drowsi ness or stupor; dizziness, deafness, and ringing or buzzing in the ears; morbid sensibility of the skin and muscles on pressure; extreme prostration of muscular strength; spasmodic twitchings of certain muscles; dull and stupid expression of the countenance; fuliginous flush of the face; suffusion of the eyes; with loss of appetite and with thirst; sometimes with a slightly altered tongue, but in grave cases, with a dry, red, brown, or black and fissured state of this organ; sordes upon the teeth and gums; occasional nausea and vomiting; frequently with a constipated or sluggish state of the bowels; the skin of the body and extremities being generally the seat of an abundant eruption, coming out in most cases between the fourth and seventh day of the disease, and declining at uncertain periods during the second and third week,

consisting of small spots, generally somewhat obscurely defined, and irregularly shaped, not unfrequently grouped and confluent, of a dusky, dingy red color, not elevated above the surrounding surface, and disappearing only imperfectly or not at all on pressure; the body of the patient in grave cases giving out a pungent, offensive, and ammoniacal odor; which symptoms differ very widely in their duration, in their march, in their severity, and in their combinations, in different cases; several of them being frequently wanting, but enough of them being generally present to characterize the disease; the most constant of which are the loss of strength, the stupor, the suffusion of the eyes, the fuliginous skin, and the dusky cutaneous eruption; which symptoms may either gradually diminish in severity, and finally disappear between the seventh and thirtieth days of the disease, or may increase in severity and terminate in death between the third and twentieth days from their access; the liability to a fatal termination being much less early than late in life: the bodies of patients exhibiting, on examination after death, no constant pathological changes of any of the organs; but in a considerable though varying proportion of cases, engorgement of the vessels of the brain with moderate sub-arachnoid serous effusion; engorgement of the pos terior portion of the lungs; redness of the mucous membrane of the bronchia; softening or mamellonation of the mucous membrane of the stomach; the blood being generally of a dark color, often fluid or grumous; the coagula, when formed, soft and non-fibrinous; and the body in many cases running rapidly into decomposition; -which disease, thus characterized and defined, constitutes a peculiar individual affection, differing essentially from all others, although related by many analogies to typhoid fever.

CHAPTER XII.

BIBLIOGRAPHY.

FOR reasons which must be sufficiently obvious, the literature of typhus fever is mostly British. I shall enumerate only those original treatises which have fallen in my way, and which I have used, more or less freely, in making up the preceding history.

Observations on the Diseases of the Army. By Sir John Pringle. Dr. Rush's edition. Philadelphia, 1810. Pringle was attached to the British army, in the Low Countries, from 1742 to 1745, and also in 1747 and 1748. His experience as an army physician was mostly confined to this period of his life. The only portion of the observations of which it is proper to speak particularly here, is that relating to the jail, or hospital fever. This is short, occupying, together with a reply to De Haen, only sixty pages, but worth its weight in gold. His general description of the disease, in six pages, is capital. His clear and unequivocal recognition of the specific and essential difference between the two great forms of continued fever, typhus and typhoid-called by him jail or hospital fever, and miliary fever-has already been referred to.

Medicina Nautica: an Essay on the Diseases of Seamen, etc. By Thomas Trotter, M. D., etc. London, 1803. This is a somewhat famous book-rambling, desultory, and egotistical; flaming with patriotism, as it ought to be, since its materials were "gleaned amidst the laurels of the British navy, and protected by its banners; sprinkled with his personal difficulties with his subordinates and superiors, and sneers at Dr. J. Carmichael Smyth's nitrous fumigation, which he calls "a mock-heroic placebo" for destroying bad smells-but withal rather an agreeable and racy book, whose leaves one can at least turn over with some pleasure and a little profit. Dr. Trotter saw much of true typhus as it originates and prevails on shipboard. The origin of typhus on board crowded ships seems very analogous to its frequent occurrence in Irish. cabins.