of the cause of the disease, is rendered incapable of performing the functions essential to the continuance of life.

In these cases there is a complete suppression of all the secretions; and the torpor of the liver especially, is so great, that no remedial measures have power to arouse it. In one case in the same neighborhood the liver, on post-mortem examination, was found congested, and both the gallbladder and its ducts were entirely free from the presence of bile.

CONGESTIVE FEVER-CHOLERINE FORM.

In every form of a congestive fever "the innervation of the extreme vessels fails, and they cannot therefore perform their part effectively in the circulation. The blood enters them with difficulty in their enfeebled state, and is carried through them very slowly; hence the paleness, and the lividness of the surface, owing to the stagnation of the blood. From the same approach to nervous death in these vessels they allow the watery portion of the blood to ooze through them, almost as through dead membrane; hence the profuse sweats. The coldness obviously arises from the languid circulation and deficient change of blood. This condition of the capillaries may co-exist with considerable power in the heart, for the want of innervation is not necessarily equal in the whole circulation; but sometimes the deficiency is experienced first, and especially by the heart. In such cases syncope or a tendency to it is the prominent symptom." (Wood.) On the same principles we can account for the oppression of the chest and want of breath, the deep sighing, &c., which accompany congestive attacks, in which the lungs are the central point of invasion. From the same deficiency of innervation the pulmonary capillaries cease to carry forward the blood with the usual rapidity, and the due aëration does not take place.

In the cholerine form of congestive fever there is deficient innervation of the stomach and intestines, producing the oppression of the stomach and free vomiting. The insupportable nausea and feeling of utter prostration has been compared to the "distressing sensations of a half paralyzed limb.” "The bloody serum, or pure blood," says Dr. Wood, "discharged from the stomach and bowels, escapes through the coats of the vessels, exactly as blood percolates through the tissues after death, with this exception, that, as the vis a tergo still continues in some degree, it adds a vital expelling force to that of mere physical transudation. The alimentary canal may be said to sweat, like the external surface."

In these cases there is at first no inflammation of the gastro-intestinal mucous membrane; and in the protracted cases, though inflammation may be developed, it is not the source of the extreme symptoms. The softening of the tissue is ascribed in great degree to depressed vitality; and the stagnation of the blood produces discoloration in other tissues besides the skin, which in these cases becomes purple or livid.

The sensation of internal heat is not evidence of inflammation, or even congestion; for there is no real internal increase of temperature. We see patients complaining, that they are burning with heat within, as well as

on the surface, when the tongue and skin are cold. These morbid sensations all arise from defect or derangement of innervation. The excessive thirst is to be explained in the same way. It is a constant symptom in "all conditions of disease in which the capillaries are emptied of their blood." "The congestion," says Dr. Wood, "necessarily follows the prostration of the active circulating forces. The pulmonary capillaries, heart, and the systemic capillaries are all enfeebled; the blood therefore collects in the veins and in the great internal organs, especially in those connected with the portal circulation; hence the congestion of the liver and spleen. When the circulatory movements return with their wonted activity, under restored innervation, the congestion is speedily dissipated." (Practice of Medicine.)

EPIDEMIC ERYSIPELAS-"BLACK-TONGUE."

This formidable disease invaded various parts of the United States and Canada about 1841. In 1842, 43, 44, and 45, it prevailed, at one time or another in almost every western state. It afterwards gradually diminished in virulence, losing its most striking characteristics. A single case will furnish a sufficient history of the epidemic as I often saw it during those years.

Mrs. M., aged twenty-five, was in good health on the evening of the 19th of March, 1844, felt some pain and soreness in one nostril, and through the bead. During the night the pain increased, the nose swelled and the eyes could not be opened. In the morning erysipelatous inflammation was extending along the angle of the right jaw. At 9, P. M., the pulse was 100 in frequency; arterial action not strong; skin moist, but the inflamed surface fiery red; pain burning and confined to the skin; heat of surface generally not great. The swelling and redness, however, continued to extend, assuming a deep, dark red color. At 4, A. M., on the 21st, the pulse was 120, pain in the head, much worse among the parotids and salivary glands. During the morning the pulse was 130, in the afternoon 140. The face largely swollen over the right side and red on the left; pain in the head continued. The tongue from the beginning coated, now dry and red. Appearances continue the same through the evening, pulse constantly 135 to 140. Swelling extending upwards through the hair,-the swelling closes the right eye.

March 22, 8, A. M. The pain is now scarcely felt though the swelling of the face is such as would be made by adding two inches in thickness at the middle of the cheek and extending it down the neck and up to the top of the head; color like dark mahogany; pulse 136. The throat collects full of thick mucus which seems coming off. The patient thinks she is better. The pain in the back and legs is gone; intellect little disturbed; mammary secretion increasing, though the pulse is still too frequent to assure her safety.

At 6, P. M. the swelling was slightly diminished on the points first invaded, but is increasing on the top of the head and on the other side of the face; some discharge from the nostrils; pulse improving (120); super

ficial inflammation still slowly spreading but with less swelling. From this time the disease declined.

March 23d, pulse 120 in the evening; face and head still very large; skin dark; nose running bloody serum; slight pain in the head; skin thickened and red quite down to the neck, front and back. Itching of the skin and subsidence of the swelling and pain, give assurance of resolution in the parts first invaded.

March 24th, free from pain; pulse at 6, A. M., 110; swelling slowly subsiding, though the eruption spreads down the neck; both eyes still out of sight from the swelling of the lids.

March 25th. Slowly improving; pulse 104. The eruption has ceased to extend; appetite good; little perspiration; tongue moist and of natural appearance. Full recovery about the seventh day.

MALIGNANT DOUBLE TERTIAN OF THE MISSISSIPPL

A severe paroxysm of chill at ten in the morning, and a light one at four, P. M., on the following day. Some patients die in the first cold stage, sinking immediately into fatal collapse; and few survive the third chill without very active treatment has preceded it. In many cases the stomach and bowels take on a choleric action. Some, after one or two convulsions, sink into profound coma; and in these cases, where there is a show of reaction, it is feeble, irregular, and terminates in icy coldness of the skin; the tongue moist, very pale and clean, or covered with a blue moist fur; little thirst.

This "sinking chill" has been mistaken for Armstrong's "congestive typhus," but they are antipodes in pathological condition. (Dr. Hogg, Fevers of Natchez, 1836, &c.)

TREATMENT.-In the initiatory stage Dr. Kellogg succeeded with a few doses of Bryonia in the morning, and Nux-vomica at night.

Second Stage.-Arsenicum and Rhus-tox. the chief remedies. These remedies, with Belladonna, Bryonia, and China, were always successful, with no other aids than occasional sponging with cold water.

BILIOUS TYPHOID FEVER.

Phosphoric Acid.-Dr. Pearson, of Mount Pleasant, Iowa, gives a case:A young man, aged nineteen, having been sick ten days, and abandoned by his physician as incurable.—Symptoms: Wild muttering delirium,—talking incoherently; inability to articulate distinctly, or to protrude his tongue, which was dry, covered with a dark fur, and tremulous; pulse weak-150 per minute; extremities cold; diarrhoeic stools, which were passed involuntarily.

Phosphoric-acid, 120, four drops in four ounces of water, two teaspoonfuls every two hours.

In twelve hours improving:-pulse 120; bowels better. There was then gradual improvement, so that in forty-eight hours consciousness was restored, and the diarrhoea had entirely ceased. Recovered in less than three weeks. Took only Phosphoric-acid, 120, Bryonia, 120, and Rhus

toxicodendron, 120.

A similar case, which was regarded as an extreme one, was treated in the same manner:-A girl, aged thirteen years, thoroughly drugged by two physicians, under whose care a sister had died, presented all the symptoms of typhus in the worst form,-unconsciousness; involuntary diarrhea; pulse weak, and 150 per minute. This case was cured by the above remedies at the thirtieth attenuation. An obstinate cough, threatening consumption, remaining after recovery from the fever, required Sulphur and Iodine, 2000, in alternation, every four hours. Four months after the last visit it was "impossible to recognize in the healthy looking girl the slightest resemblance to the emaciated patient previously treated." Dr. Pearson says: "Phosphoric acid is the only medicine I have ever found capable of making a speedy impression on the pulse in this disease; and whoever prescribes it below the twelfth dilution, and continues to repeat it often, will run the risk of losing his patient. These conclusions cannot well be called hasty, since years of experience have amply confirmed them. “Some diseases, both acute and chronic, appear to require for their successful treatment medicines as high at least as the twelfth attenuation; among the former are typhoid, typhus, and lung fevers."

Influence of the Mind on the Body in Disease.

The resources of medicine are not confined to the materia medica. In the present day they are all needed. "It is the duty," says Sir A. Cooper, "of the physician to support hope, preserve tranquillity, and to inspire cheerfulness, even when he is doubtful of the issue." A kind expression, an unobtrusive inquiry, a word in season betokening interest and regard, may serve to draw out the real cause of a pining malady which has long resisted the best efforts, and may thus lead to its cure. And a noble effort of the soul may bid defiance to physical agony and put a temporary check to the onward march of death.

If a man submits himself to his fate without repining; if he yields to the

advice of friends, and consents to all the treatment proposed, he generally does well. On the contrary, if he bitterly deplores his fate, is too anxious about the means of cure, and impatient when relief cannot at once be obtained,-we may then consider that a constitutional irritation highly unfavorable to recovery exists. In this day "moral therapeutics" possess a higher value than in former times. We have high degrees of mental disquietude in all classes of society; we have the excitements of progressive civilization of misdirected education and discipline, of commercial vicissitudes, political agitation, with all the disturbing elements that spring from all the passions. We refer briefly to a few of the prominent passions and their effects on physical health.

GRIEF. The specific effects of grief are often witnessed by physicians when their efforts to prolong life has been unsuccessful. It lowers the action of the heart and arteries, and all the physical powers; arrests the secretions, especially that of the liver; and produces a low feverish state; there is defect of animal heat; the appetite fails; the mind becomes weaker. The three worst forms of disease to which man is liable-insanity, cancer and fungous hæmatodes-may arise from excessive grief. Anxiety of the mind produces diseases of the chest. The nerves and muscles lose their accustomed tone and energy. Over-anxiety sometimes causes sudden death from cerebral or cardiac lesion. A clergyman, who had preached at an hour when he was in a state of great anxiety to return home to his wife who was dangerously ill, fell dead in the pulpit immediately after he had pronounced the blessing. Diseases of the heart were little attended to before the French revolution; but the trying scenes of that period called forth such a multitude of cases of this fatal disease, that a volume was soon written on the subject by Corvisart, who ultimately died of the same disease. The state of the stomach is modified by every impression on the mind; and thus arise dyspepsias, hæmorrhoids, hypochondriasis, jaundice. FEAR.-Fear exerts a stronger influence over the powers of the body than any other emotion. When a patient declares that he cannot recover, this prepossession appears, says Cooper, to deprive the constitution of all powers to restore the body to health. A man came to this great surgeon with a stone in the bladder; the bladder was examined by a sound and the stone was touched. The patient was unwilling to believe it as he said he never could endure the pain of an operation for extracting it. The thought of it so weighed down his mental powers that he returned to the country and in a few days died. (Cooper's Surgical Lectures.)

Under the influence of fear the whole muscular system, involuntary as well as voluntary, is relaxed and unstrung; the skin is chilly and damp; the body is unable to originate its accustomed amount of heat; the circulation is hurried and irregular, and the blood is unequally distributed; the breathing is short and rapid, or takes place in intermitted deep-drawn efforts; the nervous system of sensation is, for thetime, in a state of exquisite and over-wrought tension, but soon to be followed by one of relaxation and exhaustion. Thus all the effects produced by fear or terror in a high degree are essentially depressing and enervating. When the degree in which the emotion becomes lighter the effects are of the same general character.