had a long continued practice in fever, we may often observe that the former employs a too vigorous antiphlogistic treatment in the commencement of the disease, and delays the exhibition of stimulants until the powers of life are sunk too low, while the latter is much more cautious in husbanding the strength of his patient, and shews much less fear of resorting to wine and other stimulants. It is in determining on the use of wine in fever that the junior or inexperienced man feels the greatest difficulty; it is in its exhibition that he betrays the greatest uncertainty and fear. This is to be explained by referring to the general character of the doctrines which have prevailed within the last quarter of a century, and which are only now beginning to yield to a more rational pathology. The doctrine of an exclusive or almost exclusive solidism, which referred all diseases to visible changes of organs, which taught that inflammation was the first and principal morbid phenomenon, and that fevers were always the result of-or accompanied with-some local inflammation, was, how cases. sence of ulcerations. (See Dublin Medical Journal, vol. x. pp. 17, 101.) But the fact is, that intestinal ulcerations have been repeatedly observed in the typhus of Ireland, their amount and frequency varying with the epidemic influence. Of this we have abundant evidence in Doctor Cheyne's Reports. (See Dublin Hospital Reports, vols. i. and ii.) And in the epidemic of 1826 and 1827 we observed the follicular ulcerations (dothinenteritis of the French) in the greater number of In many instances perforation took place, and the whole group of vital and cadaveric phenomena, corresponded almost exactly to the dothinenteric typhus of the French authors. The prominent symptoms were thirst, nausea, epigastric tenderness, vomiting, diarrhoea, and tympanitis, and in almost every dissection we found the ulcerated patches of the small intestine. Since then no severe or decided epidemic of fever has occurred, but cases of typhus are to be met with, with or without this peculiar lesion. The researches of Dr. Bright and others in London, and of Dr. Staberoh in Glasgow shew, that ulcerations of the intestine occur not unfrequently in the typhous fever in these situations. We cannot then found any general distinction of British or Continental fevers on this circumstance, the difference is in the degree of liability. This may be explained by local circumstances, and original dispositions inherent in particular races. ever disguised under various denominations, the doctrine taught to the majority of our students. Their ideas were thus exclusively anatomical; inflammation formed the basis of their limited pathology, and thus instructed, they entered on the wide field of practice, most of them having never even attended a fever hospital; utterly ignorant of the nature of essential fevers, they applied, in the diseases of debility, the treatment of acute local inflammation, and delayed stimulation until nature could not be stimulated. Let it not be supposed that in this picture I seek to make a favourable contrast between the education which I myself received, and that given to others. Far from it; I confess that it was not until several years after I commenced practice that I became fully aware of the erroneousness of what is termed the anatomical theory of disease; and I feel certain, humiliating though the confession may be, that the fear of stimulants in fever with which I was imbued, was the means of my losing many patients whose lives would have been saved, had I trusted less to the doctrine of inflammation, and more to the lessons of experience, given to us by men who observed and wrote before the times of Bichat or of Hunter. The hospital physician will be frequently asked by students to state the principle on which he administers wine in fever, I conceive that the question may be thus answered. Typhous fever is a disease which has a tendency to a spontaneous and favourable termination, but one in the course of which the powers of life are attacked by a most malignant influence. By wine, food, and other stimulants we support nature, until the struggle is past, so that, to use the words of an ancient author, which embody a more profound principle than appears at first sight, we "cure the patient by preventing him from dying," that is to say, we prolong his existence until the natural and favourable termination of the disease arrives. We do not allow our patients to die of exhaustion, and bearing in mind the depressing influence they have to struggle with, we give stimulants at the proper time, and with a bold hand. We give our patients an artificial life, until the period arrives when nature and health resume their sway. Yet, though we may admire the practice of an experienced physician in the use of wine in fever, it will often be found that he has a difficulty in expressing any exact reason for adopting the practice in a particular case. His practice is founded on a knowledge which is often incommunicable, an almost instinctive perception of the necessity for stimulation, characteristic of the great physician, and only to be obtained by a long and close familiarity with the disease. But is there any rule by which the inexperienced man can be guided? any one distinct phenomenon, the observation of which is easy, and leading to an intelligible and communicable rule of practice. If the following statement of facts shall assist the inexperienced man in the treatment of a single case of fever, I shall feel more than rewarded, for I am convinced that it is to the fear of wine, or to ignorance of the principles of its exhibition, that we are to attribute the loss of many lives in the typhous fever of this country. I shall first speak of the influence of wine on the circulation in fever, and examine the phenomena of the pulse, the force of the heart, and the character of its sounds. We have long observed, that when under the influence of wine the pulse became less and less frequent, the termination of the case was generally favourable, and as might be expected, the contrary result led to a bad prognosis. This practical observation I do not put forward as original, but I wish to express my great confidence in its truth. Let us suppose a case of typhus on the tenth day of fever, and presenting severe symptoms of prostration, the pulse varying from 115 to 120. Wine is exhibited, and on the first day the pulse rises to 125, on the second to 130, and if on the third day there is no diminution, we may make a bad prognosis; and thus the following rule may be laid down, that when in a case where the symptoms seem to indicate wine, the pulse either does not come down, or increases in frequency under its influence, we may expect a bad result. These facts naturally lead to the examination of the state of the heart in typhous fever, and the cases in this report are so arranged, as to exhibit together the condition of the heart, and the amount of wine employed. In this investigation we have sought for an additional rule, drawn from the state of the heart itself, to guide the inexperienced man in the exhibition of wine, and I am not without hopes, that in the careful study of the cardiac phenomena, an indication hitherto unobserved will be obtained. In typhous fever two opposite conditions of the heart may be observed; in the one the impulse becomes extremely feeble, or altogether wanting, while the sounds are greatly diminished in intensity; while in the other, the heart's action and sounds continue vigorous throughout the whole course of the disease. These opposite states are not necessarily revealed by the state of the pulse, or the warmth of the surface. We We may observe a hot skin, while the action of the heart is almost imperceptible, and on the other hand a patient may be pulseless, cold, and livid for days together, while the heart is acting with the greatest vigour. The condition of the heart must be determined by the application of the hand and stethoscope to the infra-mammary and sternal regions. Of this principle the following case is an illustration: CASE I.--Petechial Typhous Fever with extreme prostration ; Failure of the Pulse, and Coldness of the Breath and A middle aged woman was admitted into our wards in February 1837, at an early period of her fever. She had attended upon and washed the clothes of a person who had died of a peculiarly malignant fever, yet on admission, and for several days subsequently, she presented no symptom beyond those of an ordinary and rather mild case of maculated typhus. From the first, however, she had a strong presentiment of death, which nothing could shake; she gradually became more and more collapsed; the surface was of a violet hue; the countenance sunken; and the skin and breath cold. From the eighth day no pulse could be perceived at the wrist, although the heart's impulse was strong, and the sounds remarkably distinct. She continued in this condition for some days, during which time stimulants of every kind were freely resorted to; on the fifteenth day the surface being icy cold, but the heart still acting with vigour, while no evidence of organic disease could be found in the abdomen or head, I advised transfusion, which was performed by my colleague Mr. Smyly. About six ounces of recently drawn blood were injected into the median basilic vein; a slight reaction followed, and the breath, which had been cold for several days, became warm. The pulse, however, did not return, and she died three days after the operation. On dissection no organic lesion of any kind could be discovered in any part of the body; the heart was firm, and its muscular structure natural; no obstruction existed in any artery, but the whole quantity of blood seemed much diminished; the consistence of the blood was somewhat pitchy, and its colour very dark. The wound in the arm was still gaping, and did not present the slightest appearance of adhesion or inflammation. This was certainly a rare form of fever, but, nevertheless, it establishes the point, that without any mechanical obstruction, we may have in fever, absence of the pulse, while the heart continues to act with vigour, and the case is one out of several which go to establish the conclusion to which I think we must arrive, that a vigorous action of the heart in typhus points out that stimulants will not have so beneficial effect as in the |