none subsequently. He thinks quinine given in this way promotes and prolongs the sweating stage, and says, that "while this is kept up the patient is safe." Tepid sponging when the skin is hot, footbaths under the bedclothes when the heat has subsided, mild diaphoretics, are his chief adjuvants. On the approach of the black vomit, and in the stage of acid secretions, he gives some alkali, and minute doses, twentieth of a grain or less, of morphine, with champagne, ale, beef-essence, &c. As to stimulants, in general he allows the patient to choose-brandy and water, port wine, or ale. Calomel finds no favor with him; and opium, except in minute doses, "produces stupor and death, for the patients with this disease are peculiarly susceptible to morphine; stimulants are much better."]

SEC. VIII.-Prophylactics. There can be no doubt, I suppose, that the most effectual means of warding off the disease from those who have been exposed to its essential cause, are to be found in cleanliness, temperance, and cheerfulness. The two former conditions it is not difficult to comply with; but according to what code of metaphysics or philosophy, the solemn warnings to men, standing in the very shadow of the wings of the angel of pestilence, to be of good heart, and not afraid-and this too at the peril of their lives -are expected to be heeded, is more than I am able to understand. In connection with the prevention of the disease on shipboard, Dr. Barrington says: "The chloride of lime is an important agent in purifying places inaccessible by the scrubbing-brush and holy-stone, and destroying the noxious effluvia of crowded apartments. That it is highly useful on shipboard has been sufficiently demonstrated. It is now in general use in the West India squadron. In the late cruise of the Erie, this article was dealt out unsparingly and occasionally to the temporary annoyance of those on board; and I am. convinced that to this, with the prompt and effective co-operation of the executive officer, in having every tangible part kept free from filth, may be chiefly attributed that ship's escape from the most alarming disease of the tropics. The chloride mixed with water was poured into the pump-wells, and distributed throughout the holds, chain lockers, berth-deck, and other parts." "Music," continues the same sensible writer, "though not often regarded as a preventive, is in my opinion an important means of placing the system, through the influence of the common sensorium, in a favorable condition to resist the action of the morbific causes. Smoking

tobacco must also be enumerated amongst the means of keeping off attacks of fever in what are called miasmatic situations. In an infected atmosphere, particularly at night, I have seen and experienced sufficient not to doubt its utility." ["Constant and brisk employment (short of fatigue), under awning, was the best prophy. lactic for seamen," says Dr. Blair.]

SEC. IX. Conclusion. I shall finish this chapter with the following conclusions, which we are justified, I think, in adopting.

The simple and milder form of yellow fever, occurring sometimes in unacclimated adults, but more frequently amongst the acclimated or partially acclimated, and in children, usually terminates favorably, independent of any of the ordinary modes of treatment. Perhaps this termination is promoted by a mild but efficient cathartic, [and moderate diaphoresis].

The open inflammatory form of the disease is mitigated in severity, and its danger diminished, by prompt and pretty free bloodletting-general and local; and by an efficient cathartic.

The congestive form of the disease, and the other forms, if they pass into the stage of collapse, usually terminate fatally, and are but little under the control of art. In these cases, the method of treatment usually followed by Spanish practitioners, and adopted by the physicians of Mobile, seems to promise more success than any other.

Finally, and lest some of my friends may think me over cautious in my conclusions, I shall add to what I have said the seal of hoary wisdom, and the sanction of ripe knowledge. Lempriere says: “I am very apprehensive, from experience, that both parties have been too sanguine in their practice, and that many of the successful cases have been confounded with the common remittent; and that as yet we have not ascertained what is the most judicious mode of treating the disease; and I am likewise convinced that there are many cases which from the first attack are fatal, and which from their nature totally exclude the chance of recovery by medicine."

Let us listen to the great Sir Gilbert Blane. He says: "I feel this as the most painful and discouraging part of this work, the yellow fever being one of the most fatal diseases to which the human body is subject, and in which human art is the most unavailing. "It seems hardly to admit of a doubt that there are particular

Amer. Journ. Med. Sci., Aug., 1833.

2 Obs. Dis. Army. Lempriere, vol. ii. p. 92.

instances of disease in their own nature determinedly fatal; that is, in which the animal functions are from the beginning so deranged, that there are no possible means in nature capable of controlling that series of morbid motions which lead to dissolution. Of this kind appear to be the greatest number of cases of the plague, many of the malignant smallpox, and some of fevers, particularly of that kind now under consideration."

Obs. Dis. Seamen, p. 411.

CHAPTER XI.

DEFINITION.

YELLOW FEVER is an acute affection, occurring at all ages, but much more frequently during the middle and active period of life than either earlier or later; attacking, in a large majority of instances, persons who are not permanent residents in the places where it prevails; sometimes extending, however, especially in localities where it is of rare occurrence, to such residents; rarely occurring twice in the same person; much more common in the white than the negro race; generally milder in its character amongst children and women than amongst men; confined to certain geographical localities, and especially to commercial seaports in hot climates; prevailing most extensively during the latter part of the hot season; often epidemic, but sometimes sporadic in its appearance; not capable of transmission from one person to another in a pure atmosphere; depending for its essential cause upon a poison of terrestrial origin, the nature and composition of which are entirely unknown; which poison may be shut up in ships, in small and close apartments, in clothes, bedding, and so on, and transported from one place to another, and which is destroyed by a freezing temperature; sudden in its access; commencing commonly with an initiatory chill, ordinarily of moderate severity, and of short duration; the chill accompanied with acute and violent pains in the head, back, and limbs, or immediately followed by them; then by a red suffusion of the eyes, moderate heat of the skin, and moderate acceleration of the pulse, loss of appetite, and thirst; a moist, white, villous tongue, with rosy tip and edges; these febrile phenomena diminishing in activity, and mostly disappearing in from twenty to thirty-six hours; the first stage of the disease, thus characterized, passing, in mild cases, into convalescene but in grave cases being followed, after an interval of a' deceptive amelioration, by nausea and

vomiting, the matter ejected from the stomach in cases that are to terminate fatally resembling coffee-grounds; black or dark-colored stools; epigastric distress, general restlessness, and jactitation; sighing respiration; hiccough; a yellow color of the skin; coldness of the extremities, gradually extending to the trunk; and, finally, by death, the mind usually remaining free, but apathetic and indifferent, up to the close of life; which symptoms differ very widely in their degree of severity, and especially in their number and combination, in different cases, thus giving rise to different varieties and grades of the disease; which symptoms, furthermore, may either subside and disappear in the course of a few days from the time of their commencement, or may terminate with death between the third and seventh day of the disease; the bodies of patients exhibiting on examination after death, in most cases, a yellow or buff color of the liver, with or without dryness of its tissue; black spots or masses, more or less numerous, in the lungs; softness and flabbiness of the substance of the heart; and in many cases unusual thinness and fluidity of the blood; and redness, mamellonation, changes in the thickness, and softeningone or more of the mucous membrane of the stomach; this organ and the intestines usually containing a considerable quantity of a very dark or black fluid or semi-fluid matter; which disease differs essentially from all others in its causes, its symptoms, and its lesions; and is only to a moderate extent, at least in its graver forms, under the control of art.