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When icterus or ascites were the most prominent disorders, of course some variation in the treatment was required.

Several cases of petechial typhus were met with in the months of April and May. In their character they were the same as were occurring at the same time at the Bellevue establishment. Accompanying the usual symptoms, there was one that we have not seen mentioned by authors; it was an inflamed state of the fauces, which in a few days assumed an oedematous appearance, the root of the tongue at the same time becoming swelled and affected with an intense soreness. Stimulating liniments and yeast gargles gave much relief. Blisters to the epigastrium were sometimes found necessary to relieve a dull, oppressive pain, and tenderness in that region. Large doses of calomel frequently repeated, followed occasionally by castor oil, and mucilaginous drinks, were chiefly relied on until a returning healthy state of the skin, and lessened coating of the tongue began to show an altered state of the disordered digestive secretions, when ammonia in excess in the spirits of mindereri, weak infusions of colombo, seneca, and serpentaria in combination, and an occasional purgative, were all that seemed required for a successful termination of the disease.

In the cases that have been seen this season in different parts of the city, no instances, we believe, have been known that will give support to the doctrine of personal contagion in this fever. It is true that several members of the same families, where they occupied the same building, have been affected, but the causes which produced it in the first instance, were capable of producing it in all the others. In one house occupied by four or five families, two in one of them, and three in another, had the fever, but none of the many persons who visited it, nor any of the inhabitants of the neighbourhood, were affected with this or any disease that could be traced to contagion. Upon examination, no cause whatever could be discovered in or about this house for the appearance of the disease, unless an extensive syphilitic ulcer on the skin of a man who afterwards died in the Fever Hospital at Bellevue, as we understand, of this fever, could be called

such. The house was remarkably clean for one occupied by this class of our population, and far worse and more neglected sloughing ulcerations in more filthy, ill-ventilated, and wretched habitations have been seen, but they never, to our knowledge, so infected the atmosphere with an effluvium, capable, by decomposition, of producing a malignant fever, which by virtue of its peculiar properties, could reproduce its like in any number of cases. The fact that we have mentioned may serve, however, as evidence to confirm the belief of those who are of opinion that decomposed human effluvium is the cause of typhus, and that this when it has once taken place, is capable of giving rise to a miasm completely elaborated, and which, from some peculiar combination of its principles, is personally contagious. If human effluvium be the cause, how does it happen that in situations and seasons unfavourable to any such origin, in families and places, when it is impossible in reason even to entertain for a moment a suspicion of this kind; how does it happen, we say, that under such circumstances, typhus even of a malignant character is not unfrequently met with? As to personal contagion, we are skeptical in any thing that has even the shadow of a leaning to such an opinion, and think the doctrine far more untenable, than that of the generally supposed original cause of this fever. We believe, as we have stated in a former paper, that typhus, the remittent and intermittent, are identical, arising originally from the same cause, but assuming their peculiar types in the first instance, with a liability to run indiscriminately in their progress into each or either of the other forms. Since the date of that report, we have had opportunities of conversing with intelligent physicians from different parts of the state, and from the results of the information obtained from them, have seen no reason to alter the opinion then expressed.

Now it seems to be granted even by those who deny this identity, that it is possible for any of the ordinary causes of fever to give rise to specific typhus, and very frequently indeed, to give a typhoid character to any fever from the first, but that this is dependent upon certain circumstances connected with a depressed state of the nervous system. This

concession or modification, affords an argument that leads us to the reasonable conclusion, that this predisposing state is the peculiar one required to give in every instance that character to fevers, which makes the only difference in the threeforms we have mentioned. The second, or pyrectic stage of an acute paroxysm of intermittent, at the time could scarcely be distinguished from a remittent or typhus in their essential symptoms. There are indeed slight differences, but these do not afford the necessary symptoms which indicate the prominent seats of disorder. And it is as Clutterbuck remarks, "only by observing the termination and recurrence of the paroxysm that the distinction can be made. An identity of symptoms-as he truly says-therefore shows an identity of disease." Now, no man will for a moment attach a contagious character to a remittent or an intermittent, not even, we believe, if they should assume a typhus complexion; and we are not able to perceive any distinction between a fever, whether it be originally a typhus, or whether it begin in either of the other varieties, and terminate in a well characterised form of that fever. The course of the latter, it is true, is different, but after it puts on a certain form, there is really no distinction. Finally, if typhus is in fact personally contagious, and this contagion arises from infectious secretions from the body, some proof should be adduced, capable at least of demonstrating this peculiar decomposition or elaboration of poisonous effluvium from the system; some evidence so conclusive, that a mind open to conviction could not well resist it. But this is not the case, nor will it be, while the circumstances in favour of contagion itself are so deficient in accurate detail, and so capable of being reasoned away, or at least of leaving strong doubts upon the subject.

There is a fact connected with this fever, which we may just mention here, as it is thought to serve in some degree to show the length of time after the cause first affects the system, before it discovers its effects in the peculiar symptoms of the disease. It would seem from some observations made on the Penitentiary fever that prevailed in that establishment, that this interval is two weeks. In 1825, when this fever was

raging there, the convicts were removed en masse from the prison, and confined in the hospital. This was done as a preventive in the case of those prisoners who still apparently enjoyed good health; but more or less of them continued to fall sick for the length of time we have mentioned, after which not a single case we believe occurred. The subjects of disease, it is well known, although they may be equally exposed to the causes, are not alike susceptible to the reception, or rather to the effect of those causes. The powers of

the system of one may throw off the miasmatic virus of the atmosphere for a time, and at length become affected, while another will immediately suffer from its poisonous influence. As no new case occurred after two weeks from the period when the prisoners were removed from the pestilential atmosphere of their cells, and of course, from any possible chance of receiving into the system the noxious miasm to which they were then subjected, it was thought to be a fair presumption, that it required that length of time for the cause to operate upon the system before its effects would be shown.

In concluding this report we may here remark, that from the nature of papers of this kind, we are obliged to speak in general terms; and also, that from the character and habits of the persons who come under our care, the diseases require in most instances, a plan of treatment that may not seem to those who are unacquainted with the circumstance, to be correct practice, or as being applicable to the cases of respectable private patients. The diseases of a large majority of Dispensary patients, are either directly or remotely produced, or in some way affected by the intemperate use of ardent spirits. The influence of such habits, and the consequent misery attendant upon such a course of life, need only to be mentioned, for to most they are well known. But although the plan of treatment may from these circumstances be somewhat peculiar, still the principles of medical practice, if correct, we conceive are always the same; but observation and judgment are necessary to make a right application of them, and so to modify our treatment of diseases, that it may be suited to the cases before us, governed as they may be by

idiosyncrasies, temperaments, habits, and local peculiarities. There is no such thing as invariable rules in practice. How can there be, when no two cases are exactly alike? Many symptoms are as peculiar as the constitutions of men are dis-. similar, and even where there appears to be the greatest similarity, there are shades of difference which, as they are by close examination capable of being distinguished, may arise from causes that require a mode of treatment, that at first could not have been anticipated. If then we do not sufficiently particularize, it is because we can here only give sketches of what falls under our notice, leaving the outline to be filled up by the good sense and discrimination of others.

ART. VII. Case of Tetanus successfully treated. By GEO. REIDENAUR, M. D. of Lebanon, Penn.

C. K. ætat. 14, a servant of Mr. J. B. residing about two miles from this place, in August last, while overheated, imprudently went into the cellar and remained there several hours, with a view, as she said, of cooling herself.

A few days after she complained of a rigidity of the muscles of the superior and inferior extremities, a sense of uneasiness about the root of the tongue, and a stiffness about the back part of the neck, together with a difficulty of swallowing, and some febrile excitement. In short, every organ of voluntary motion appeared to have suffered more or less, and the muscles of the lower jaw became so rigidly contracted as unequivocally to characterise trismus.

An empiric was now desired to visit her, who pronounced it a very anomalous affection, and prescribed his usual balsamic remedies. He continued to attend her for ten or twelve days, when owing to the interposition of her friends, I was requested to see her. When I first saw her, the rigidity of the muscles of her body was such, that she could not bend herself in any direction, but was perfectly stiff, and her jaws were so firmly locked, that she was then, and had been for nearly a week, unable to take even liquid nourishment.

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