carbolic oil, which are laid on the sore and covered with a linseed-poultice, to be changed three or four times a day. Yeast-, carrot-, chlorine-, and charcoal-poultices, or a few drops of carbolic acid or turpentine in the ordinary linseed-poultice, are also very useful. To correct fetor, the parts are to be washed each time that they are dressed with a lotion of carbolic acid (gr. xv ad 3j), sulphurous acid (1 in 6), chlorinated soda (Liq. sod. chlorat. ziv. aq. 3ixss.), or the permanganate of potash (Liq. pot. permang. 3vj. aq. ad 3x). After the sloughs have separated, the sores are to be dressed with some stimulating lotion, and if sloughing return, strong nitric acid must be applied, followed by poultices.

7. Spontaneous gangrene. When the feet are cold and livid, external warmth ought to be applied by means of hot water bottles, or bags of hot sand or bran; and as soon as gangrene threatens the limb should be enveloped in cotton wool, over which a few drops of turpentine or spirit of camphor are sprinkled. After gangrene has commenced, the same treatment is applicable as for bed-sores, until a decided line of demarcation has formed; and then, as soon as the patient's strength permits, amputation must be performed a considerable way above. In cancrum oris, strong nitric acid must be applied freely and without delay over the ulcerated surface inside the mouth; poultices are to be applied over the cheek, and the mouth frequently washed out with one of the antiseptic lotions mentioned under the head of bed-sores. Sloughing and ulceration of the cornea are best prevented by wet compresses over the closed eyelids, whenever the patient lies with his eyes constantly open. When ulcers have formed, warm fomentations of belladonna or poppy-heads ought to be applied, and if there be much pain in the eye paracentesis of the cornea must be performed. Sloughing in any part of the body indicates a low state of the system, and calls for large quantities of stimulants, quinine, the mineral acids, and other tonics. As soon as the primary fever has ceased, malt liquors and abundance of nourishment in a digestible form ought to be allowed. Opium is usually required to relieve pain and procure sleep.

8. Erysipelas is best treated by stimulants and by the tincture of the perchloride of iron and spirit of chloroform, or quinine and the mineral acids, and by the application to the part of flour and cotton wool, or of a warm fomentation of lead and opium (Plumb. acet. et Pulv. opii a.a. gr. iv ad 3j aq.). In erysipelas of the face we must always be on our guard against a

similar condition of the pharynx and larynx; and when either of these parts become affected, the fauces, back of the pharynx, or the entrance to the larynx, ought to be freely painted with the glycerole of tannin, a solution of perchloride of iron (equal parts of the tincture and water), or a solution of nitrate of silver (j ad 3j). When the patient is unable to swallow, brandy, beef-tea, ether, and quinine ought to be given by the rectum, or introduced by a long tube into the stomach. When apnoea is imminent from obstruction of the rima glottidis, laryngotomy must be performed without delay.

9. For diffuse cellular inflammation and pyæmia the same constitutional treatment is required as in erysipelas. I have tried the hyposulphites in several cases of this sort without any good result. Opium is often necessary to relieve pain and procure sleep. As soon as matter forms, it ought to be freely evacuated, the cavity washed out with a strong solution of chloride of zinc (9j ad 3j), and the wound dressed with carbolic oil.

10. Inflammatory swellings in the parotid region and elsewhere are to be treated internally in the same manner as gangrene, erysipelas, and pyæmia. The swellings are to be covered with cotton-wool or poultices. I have never seen any benefit from leeches, but blisters applied in the early stage seem sometimes to prevent suppuration. As soon as pus has formed, it is to be evacuated by free incisions; and even before pus can be felt, when the swelling continues to increase for several days and is tense and painful, one or more incisions often give great relief, and prevent the spread of the inflammation.

II. When thrombosis of the femoral vein occurs during convalescence, the patient must lie on his back with the foot raised above the level of the trunk. A flannel-bandage is to be applied from the toes to the hip, so as to keep up gentle pressure and maintain the temperature, and be worn for some time after the swelling has disappeared. If a hard painful cord be felt in the situation of the femoral vein, strips of lint smeared with equal parts of belladonna and glycerine may be laid along the course of the vessel before applying the flannelbandage. When the pain and tenderness are unusually severe, warm anodyne fomentations, or even leeches, along the course of the vein will often give relief.

12. For ædema of the lower extremities during convalescence, tonics, especially iron, and a generous diet are to be prescribed.

Treatment during Convalescence.

As soon as the fever ceases, most patients convalesce rapidly, unless there be some complication; and the chief duties of the physician consist in preventing premature exertion and exposure to cold, and in checking the inordinate appetite. Although there is probably no acute disease in which the appetite returns more speedily, and may be gratified with greater impunity, it is well to restrict the diet, for the first two or three days of convalescence, to animal soups and farinaceous articles with milk and eggs. On the third day, if the tongue be clean and moist, the pulse slow, and the rash gone, a piece of boiled white fish or chicken, or the lean part of a mutton chop, may be allowed. As soon as convalescence is established, porter or ale ought to be substituted for the wine and brandy, as they are more fitted for promoting the transformation of food, and at the same time furnish nutriment themselves in the form of gluten and sugar.

The bowels are usually costive, and are to be kept open by mild laxatives and enemata. The mineral acids, with bark, quinine, and iron, may be given as tonics, and are particularly called for when the pulse is abnormally slow, in which case, also, the patient should be cautioned against assuming the erect posture too soon, as sudden and fatal syncope has sometimes been the result. Opiates or the hydrate of chloral may be required to produce sleep; and in every case great benefit will be derived from a change of residence and exercise in the open air.

A

CHAPTER III.

RELAPSING OR FAMINE FEVER.

SECTION I.-DEFINITION.

CONTAGIOUS disease which is chiefly met with in the form of an epidemic, during seasons of scarcity and famine. Its symptoms are: a very abrupt invasion marked by rigors or chilliness; quick, full, and often bounding pulse; white moist tongue, rarely becoming dry and brownish; tenderness at the epigastrium; vomiting, and often jaundice; enlarged liver and spleen; constipation; skin very hot and dry; no characteristic eruption; high-coloured urine; severe headache, and pains in the back and limbs; restlessness, and occasionally acute delirium; an abrupt cessation of all these symptoms, with free perspiration, about the fifth or seventh day;-after a complete apyretic interval (during which the patient may get up and walk about), an abrupt relapse on or about the fourteenth day from the first commencement, running a similar course to the first attack, and terminating on or about the third day of the relapse; sometimes a second, or even a third relapse-mortality small, but occasionally death from sudden syncope, or from suppression of urine and coma ;-after death, no specific lesion, but usually enlargement of liver and spleen.

SECTION II.-NOMENCLATURE.

1.-Names derived from its duration and peculiar course.

A Five Days' Fever with Relapses (Rutty, 1770); Short Fever, Five Days' Fever (var., 1817–19); Five, or Seven Days' Fever (Wardell, etc., 1843, Irish Writers, 1847); Remittent Fever (Craigie, 1843, Purefoy, 1853); Relapsing Fever (Paterson, Steele, etc., 1847; Jenner, 1849; Lyons and Anderson, 1861); Typhus recurrens (Hirsch, 1859); Das recurrirende Fieber (German Writers); Fièvre à rechute and Typhus à rechute (French Writers).

2.-Names derived from its Prevalence in Epidemics.

The Epidemic Fever (auct. var.); Epidemic Fever of Edinburgh (Welsh, 1819); Epidemic Fever of Ireland pro parte (Barker and Cheyne, 1821); Scotch Epidemic of 1843 (Alison, Wardell, R. Cormack, Jackson, Henderson, H. Douglas, D. Smith, Craigie, etc.); Epidemic Remittent Fever (Mackenzie, 1843); the Silesian Fever of 1847 (Brit. and For. Med. Ch. Rev., July, 1851).

3.-Derived from the supposed Inflammatory Nature of the Pyrexia. Dynamic or Inflammatory Fever (Stoker, 1835; and Dublin Journal, 1848); Synocha (Cullen, 1769; Christison, 1840 and 1858); Relapsing Synocha (Seaton Reid, 1848)."

4.—Derived from the common occurrence of Jaundice as a Symptom. Yellow Fever (Graves and Stokes, 1826; Arrott, 1843); Bilious Relapsing Fever (Steele, 1848); Gastro-hepatic Fever (Ritchie, 1855); Biliöses Typhoid (Griesinger, 1864). Has also been designated Bilious Remittent Fever, Remitting Icteric Fever, Biliary Fever, and Bilious Typhoid Fever.

5.-Derived from its connection with Famine.

Famine Fever (Stoker, 1826, and Irish Writers generally); Armentyphus (German Writers, 1848); Die Hungerpest (Grævell's Notizen, 1848).

6.-Other Synonyms.

Fever of the New Constitution (O'Brien, 1828); Miliary Fever (Ormerod, 1848; Watson, 1848); Typhinia (Farr, 1859).

SECTION III.-HISTORICAL ACCOUNT OF RELAPSING FEVER.

ELAPSING Fever, like typhus, is not a new disease. Hippocrates described a fever prevailing upwards of two thousand years ago in the island of Thasus, off the coast of Thrace, which resembled it very closely in most of its characters, including an intermission of five or seven days between the febrile attacks, jaundice, epistaxis, tendency to miscarry, &c.°

In the accounts of many epidemics of typhus, mention is made of relapses, which in some instances probably referred to relapsing fever, as this fever prevails often as an epidemic in conjunction with typhus. Strother, in describing the fever epidemic in London in 1729, speaks of frequent relapses; P and Lind, in his account of

Relapsing Fever probably constituted one of the varieties of the 'Inflammatory Fever,' or 'Synocha' of the writers of last century; more recently, it has often been considered a variety of Typhus. • SPITTAL, 1844, p. 177; Hippocrat. Op. Syd. Soc. ed. i. 389.

P STROTHER, 1729, p. 121.