so uncertain that it was of no practical importance whatever. In a few hours from the commencement, delirium occurred, the vital powers gave way, the patient fell into a state of collapse, and death ensued.

Death took place in one case in twenty-four hours, and none survived through the sixth day.

Sequelae. The disease, in the epidemic of which we speak, was followed by anasarca, and in one case rheumatism of the joints of the upper extremities. These were the only diseases that succeeded it.

Prognosis. In this epidemic the prognosis was not very difficult. In S. simplex all recovered, and many did not take their beds from it. In S. anginosa, when delirium supervened and continued without intermission, with a high grade of inflammation about the throat, pulse quick and feeble, at times the surface would get cool, great restlessness, often turning in bed and attempting to rise or get out of it, cold sweat, diarrhoea, &c., death was the result.

In the cases that recovered, about the eighth or tenth day a general abatement of the symptoms was obvious; less fever, with perspiration; delirium began to moderate; appetite improved, and countenance brighter; the tongue was moist on the edges, which gradually increased until it covered the whole mouth: the florid hue at the same time was disappearing, convalescence was fully under way, and by the fifteenth day they were able to sit up at short intervals.

The prognosis in S. maligna is generally easy. In twenty-four or forty-eight hours the delirium was complete; the prostration great, the pulse feeble, respiration hurried, great restlessness; the skin was under the ordinary temperature, with dark, congested spots about on the body and below the eyes; the countenance was of a peculiar ghastly appearance, indicative of great distress and anxiety. We saw no case without a majority of these symptoms, and they all died.

Those who died were from one to thirteen years of age, and none died who was over that age.

Treatment.-Most authors teach us that scarlatina is a disease of the skin, and their treatment is predicated upon this belief. We are decidedly of the opinion that it is not exclusively a disease of the skin, and that the eruption should be taken into very little account in determining our practice. Our attention should dwell

upon the particular symptoms attending the case, and our treatment should be directed accordingly.

In the simple variety it was hardly necessary to do any thing— all recovered; but when a treatment was adopted it was the mildest and least irritating. In the beginning, a light laxative of sulph. magnes., Seidlitz powder, or oleum ricini; during the day, small doses spirits nitre every two hours, or spiritus mendereri, or any mild diaphoretic; at bed-time a warm pediluvium; a dose of paregoric to a child, or of Dover's powders to adults, if the fever is not too high, and all will be well.

Treatment of S. Anginosa.-If any variety of scarlatina demands close attention and careful treatment, it is this. S. simplex will get well if let alone, and S. maligna almost as certainly kills; and if any good can be done, it is in S. anginosa.

In the incipient stage, an emetic of ipecacuanha was given, and followed by warm infusions, until full emesis was produced. This was done to remove, if possible, the tendency to visceral congestion, after which the stomach was quieted with an opiate, and then a gentle saline laxative, or oleum ricini or any mild aperient was administered, being careful not to induce active purging; after which diaphoretics were given-as vinum ipecac., one-third, and spts. nitre, two-thirds-every two hours, in warm, weak infusions of balm, sage, &c.; or nitrate potash, three grains; ipecac., one grain, intimately mixed, and given as above, and in doses sufficient to nauseate. Spts. mendereri may also be used, or any mild diaphoretic, with the exception of antimonials; at night, warm pediluvium. If the fever was not too high, and the sensorial functions too much disturbed, a Dover's powder was administered; when the skin became cool and pale and the pulse feeble, the mustard foot-bath was used three or four times per diem, and also a sinapism to the spine. If a reaction did not come on, carb. ammonia was given in doses sufficient to raise the pulse as often as the case demanded it. When this did not answer, brandy and water, or other stimulants, were substituted. An application of sinapisms. was made to the stomach and bowels if they were disturbed.

Much has been said and done respecting the use of cold water. In the epidemic of which we speak, no good was effected by it: in some instances injury followed its use, and it was altogether improper to use it in either variety.

Gargles were wholly useless in the early stages, and with chil

dren they did harm; but in the latter stages, when ulcers were present, they were of great benefit. The mild astringent gargles were best, such as alum, infusion of sage, honey and borate of soda; a strong infusion of cinchona, with or without tinct. myrrhæ. Strong and irritating gargles, such as salt and capsicum, &c., &c., were injurious, and cannot be too strongly condemned.

Blisters were used to the throat and nape of the neck in the incipiency, if inflammation ran high in those parts, but their use was not attended with much apparent good. They should be used with great caution.

Treatment of S. Maligna.-This variety of the disease ran its course so rapidly that scarcely anything could be done. When time was given, it was treated in the same way as S. anginosa. If the reaction was high, an emetic was given, followed by gentle aperients; in the sinking state, counter-irritants and stimulants, carb. ammonia, wine, brandy, elixir vitriol, &c., always selecting such as seemed best adapted to the case.

During the stage of excitement, in each variety, cold water was allowed in small quantity, and acidulated if desired. The diet was mild and nutritious; the rooms were ventillated, and the clothing and beds were kept clean.

From our observations in this affection, we have been led to the following conclusions:-That scarlatina is not strictly a disease of the skin, the eruption being merely an effect or an occasional symptom. We could with as much propriety call typhoid fever a disease of the skin, because an eruption accompanies this affection. We think that scarlatina is a modification of the blood, producing great prostration of the nervous system, followed by inflammation of one or more of the internal organs, occasioned by some occult effluvium in the atmosphere, of which we know nothing.

These facts considered, it is but reasonable to conclude that the treatment should be mild and unirritating, as the attack sets in with so much violence as to prostrate the patient at once. We therefore deprecate calomel purges, antimonials in any form, blisters, venesection, &c. They cannot, in our humble opinion, be too strongly condemned. As respects the application of cold water, we have ever been taught that in no disease of the throat or thoracic viscera should it be used, and we know the throat and fauces are invariably sore, inflamed, tumid, &c, This reason, of itself, is

sufficient to proscribe it. We therefore place all of the last named articles in the same category. Those strong and burning gargles never do good, and often do harm, especially with children.

ARTICLE IL

LETTERS FROM SAML. D. HOLT, M. D., UPON SOME POINTS OF GENERAL PATHOLOGY. LETTER NO. 7.

MONTGOMERY, ALA., Nov. 25th, 1855. Messrs. Editors-Notwithstanding the advancement which has been made in the science of medicine, and especially in physiology, pathological anatomy, and animal and vegetable chemistry, there has been nothing like a proportionate advancement made in the art of curing diseases; and one of the principal reasons for it, I think, is to be found in the fact, that most of our young physicians set out upon their professional career without having been sufficiently indoctrinated in the principles of general pathology. They may have been well instructed in the causes, symptoms, diagnosis, prognosis, treatment, &c., of diseases, as they are taught in the medical schools, and from their text-books, according to the most approved and correct nosological arrangement and classification, and they go forth into the world impressed with the idea, and confident belief, that they are fully prepared for every emergency, and that nothing remains to ensure their success, but to apply those rules to practice. But they often find themselves doomed to disappointment and defeat, and sooner or later discover that the systems of practice founded upon the nosological classification of diseases which they had regarded as the standards of excellence and perfection, are unsatisfactory, unreliable, and often inappropriate to the many changes and modifications which diseases are constantly undergoing, from the influence of climate, seasons, atmospheric changes, conditions, &c., which can be met and provided for only by a correct knowledge of general pathology. Now, I am not opposed to the nosology and classification of diseases, as taught in the schools, and by systematic writers generally; but I am opposed to the systems of practice founded upon the simple detail and enumeration, in their order, of the symptoms which characterize the diseases to which they respectively belong, according to their most approved nosology and classification, and I fear that

it will be a long time before we shall see much advancement made, or have any thing like a uniform and reliable system of practice established, unless the present system is changed, and diseases come to be treated, not according to their name, or the class to which they may belong, but according to the condition which they present, and the symptoms upon the merits of their real pathology. If proof is wanted in support of the truth of the assertion, that the practice of medicine has not advanced in proportion to other branches of medical science, it is only necessary to examine the history of some of the most common diseases, as described by the systematic writers of the present day, and compare them with those diseases as described by the old systematic writers who named and classified them. Take Pneumonia, for example, and what new features of the disease do we find, which they did not notice, what new indications of treatment have we to fulfil, which they did not recommend, and what new remedial agents have we which they did not possess. We have the lancet, emetics, cathartics, diaphoretics, expectorants, blisters; so had they. We have calomel, tart. emetic, opium, quinine, &c.—they had calomel, tart. emetic, opium and cinchona. We have phosphorus, bryonia, belladonna and aconite! Alas, they died before the days of Hahnemann and Homoeopathy. We have steam, lobelia, composition and number six!-but to them, the powers of steam and Doctor Thompson were alike unknown. Yet, with all the improvements suggested by these two great luminaries, it cannot be perceived that the disciples of either have made any great advancement in the healing art, or that they have improved much upon the old method of treating pneumonia, and other diseases. What success those old practitioners had in the use of the lancet, calomel, and other time-honored remedies, we have no exact means of ascertaining, unless we take as evidence the fact, that the testimony which they have given of their value and efficacy in the treatment of certain diseases and conditions, has had the endorsement of each age and generation through which it has passed; and it cannot be considered uncharitable in us to suppose, that they were as successful in the treatment of pneumonia, with those remedies, before the time of Hahnemann, as his disciples claim to be with phosphorus and aconite. Now, my idea is, that these old pioneers and fathers in physic, who named and classified our diseases, understood pretty well their special pathology, and also the power,