most frequently and pretty early engaged. Another form of eruption, which was by far the most common, was that of dusky maculæ. These cases frequently presented bronchitis; and a still rarer form was that of purple petechiae; but no cases occurred of regular vibices or blotches. The maculæ were often felt elevated and rough, and during the evening exacerbations, or under the influence of stimuli, became brighter.

In the fever which has prevailed here, I have generally observed the pulse extremely rapid; more so especially in cases complicated with epigastric symptoms. This rapidity of pulse was much greater in proportion to the natural standard in adults than in children. I know not how far this may accord with the very curious researches of Dr. Stokes, on the state of the heart in typhus; but all are aware how much more frequent disease of this organ is in the old than the young. My attention was not directed to the state of this organ particularly; but in one case in which I was much interested, the state of the heart and pulse were often compared, and in that instance its action was far greater than the pulse indicated; in fact the pulse was scarcely perceptible, when the heart was still acting pretty vigorously this case proved fatal.

The treatment employed varied much, according to the period at which the patient was seen, the combination of symptoms, and organs affected. If seen at an early period, calomel or blue pill was generally administered in combination with James' powder or antimonial powder, and tart. antimonii, followed by a saline aperient the following morning. In some instances the head was shaved, but not frequently; generally the hair was merely cut shorter and cold applied, at the same time causing the surface to be sponged, where other symptoms did not forbid its employment.

Where delirium set in early, accompanied with increased action, and where there was no tenderness of the epigastrium, I have generally employed the tart. antimonii in solution combined with opium, as recommended by Dr. Graves. Frequently,

however, the delirium was of a different character, and was treated by gentle stimulants and cordials, with or without opium, and by blisters to the nape of the neck. I have never resorted to blistering the entire scalp, and, from what I have observed, would hesitate much before doing so, except when the patient had passed into stupor, or the disease was marked by great prostration.

The tenderness of the epigastrium I found generally yielded to fomentations or blisters-sometimes to poultices. Where diarrhoea became excessive, I have employed acetate of lead and opium, camph. mixture and chalk, or hydrarg. c. creta. and Dover's powder, according to circumstances. In some cases accompanied with tympanitis, and in others with stupor, I have found the most beneficial results from the oil of turpentine, either by the mouth or in enema.

Where bronchitis was the principal complication, (which was the only form of chest affection I observed,) I have frequently trusted to the tartrate of antimony in small and frequent doses; but where it occurred at an advanced stage, I have generally resorted to the blue pill and camph. mixture, with carb. of ammonia and blistering to the back or sides; sometimes combining the ammonia with vinum ipecacuanhæ, tinct. opii camph. and syrup zingiberis.

In almost every instance where the dusky eruption appeared, there was more or less of bronchitis, with a quick small pulse, dry brown tongue, and sordes on the teeth and lips. Here the chloride of potass was frequently given, generally with camphor mixture and carbonate of ammonia, and sometimes with the addition of ether. It was also used in the form recommended by Mr. Wilson, of St. Giles, combined with muriate and carbonate of soda. Except in a few instances, I cannot say I observed the effects resulting from its employment mentioned by others, and have latterly thought the solution of carbonate of soda, in camphor mixture or water, and rendered palatable by syrup of orange peel, answered equally well. To this latter, along with hyoscyamus and blue pill, using at the same time

fomentations, I have resorted much, in cases of epigastric tenderness; it appears to relieve, and at the same time to improve the secretions, better than any other treatment.

Wine and porter were freely resorted to, when considered necessary, but not, in any instance, to the amount which Dr. Stokes has so successfully prescribed to some of his patients. Nor indeed is it probable that here such large quantities would be often required. I regret, however, that I was not long since acquainted with his paper, as I now fear I hesitated from want of some certain guide, in one or two instances, to resort to it in sufficient quantity. I have not been deterred, however, in giving it often where symptoms would have appeared to contra-indicate its use, but where the vascular powers and vital condition seemed to require it in cases accompanied with delirium, in some with epigastric tenderness, (employing at the same time blisters over this region,) and under all conditions of the tongue, except where it was fiery red, and the papillæ erect.

The preceding cases were all treated at their respective habitations; and, if permitted to form a conclusion from what I have observed, I should say, that cases of fever among the poor turn out generally as favourably when attended at their own houses as when removed to hospital. Such attendance, however, is accompanied with many inconveniences and difficulties, especially in the application of leeches, and due administration of medicine.

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ART. XIV.-Propositions relating to Diseases of the Stomach. By JONATHAN OSBORNE, M. D., Vice-President of the King and Queen's College of Physicians in Ireland, Physician to Sir Patrick Dun's and Mercer's Hospitals, Member of the Royal Literary and Historical Society of Quebec, &c.

SEVENTH PROPOSITION.-The causes of acute inflammation are the chemical action of substances taken into the stomach; sudden application of cold externally or internally; metasta sis of gout or rheumatism.

EIGHTH PROPOSITION.-Chronic inflammation is denoted by the same symptoms as chronic irritation, but in a more permanent form, and also by more or less of pain or general uneasiness immediately after eating. The tongue is sometimes natural, but is more frequently coated, and at the upper surface deprived of its natural feeling, dotted with red spots towards the points and edges, marked with dry streaks towards the centre, or intersected by deep fissures. There are sometimes aphtha and red streaks in the pharynx.

General Uneasiness.-This uneasiness assumes a great variety of forms, of which the following are amongst the most remarkable: heat of the hands and feet, chilliness with an approach to rigor; headach, mostly frontal, with dulness and inaptitude for occupation, or an indescribable sensation of misery and discomfort, causing the unhappy sufferer to be dissatisfied with all around him. It is to this latter feeling, connected with chronic inflammation of the stomach, arising from impeded circulation through the liver, that we are to ascribe the fact, that persons with broken health returned from India are so often a prey to discontent, that they cannot be induced

to settle any where, and spend the remainder of their lives wandering about through various places of resort, seeking rest and finding none. These have been often compared to the ghosts in Virgil, and formed the floating population of watering places.

NINTH PROPOSITION.-The causes of chronic inflammation are the previous existence of acute inflammation or of neglected irritation of the mucous membrane; long continued irritation of the gastric glands; open ulceration or development of scirrhous structure; irritating diet; abuse of spirituous liquors; long abstinence.

The previous Existence of acute Inflammation.-Let an attack of acute gastritis be inadequately treated, and the symptoms only palliated by purgatives, then a state of chronic inflammation ensues, which often snggests to the practitioner and the patient the notion that the work of purgation has been only half accomplished. Hence follows an administration of more active purgatives, which, from their irritating effect while in the stomach, are a source of fresh aggravation, and cause the inflammation to extend to the mucous surface of the bowels.

Long continued Irritation of the gastric Glands.-This fact is one which tends much to confound the two leading diseases of the stomach, which I have endeavoured to distinguish; for, although at the commencement of irritation of the gastric glands it is not accompanied by thirst or any other symptom of mucous irritation, yet when it has lasted some time, or come on with peculiar severity, then the quantity of sour fluid poured into the stomach, causes not only irritation, but eventually inflammation of the mucous membrane; and it is the usual course that, after long continued sour dyspepsia, the symptoms described in the present section gradually come on. When scirrhous structure has formed in the seat of the gastric glands and has ulcerated, then the symptoms of the two diseases are most unequivocally united in the one case: then, along with coffee-ground vomiting, there are also superadded thirst, loss of appetite, flushes, and