lungs in reading, public speaking, laughing and singing. The lungs when debilitated derive equal benefit with the limbs of the body from moderate exercise." In his paper on the use of common salt in the cure of hæmoptysis, he says, "Those persons who have been early instructed in vocal music and who use their vocal organs moderately through life, are seldom afflicted by an hæmorrhage from the lungs. Lawyers, players, public criers, and city watchmen, all of whom exercise their lungs either by long or loud speaking, are less affected by the disorder than persons of other occupations."

In the second volume of the Journal of Health, I find the following judicious observations on the voice, corroborating my opinion:-"The voice should never be exercised beyond its strength, nor strained to its utmost pitch without intermission; such mismanagement would endanger its power altogether, and render it hoarse and grating. Frequent changes of pitch is the best preservative. The voice, as well as the health of the speaker, suffers materially unless the chest is allowed to expand freely; hence, all compression or restraint should be carefully removed from this portion of the body; for the same reason an erect position should be assumed, as well in speaking and reading aloud as in singing. The tone of the voice is also considerably impaired, and its strength diminished, by a tightly drawn or large cravat. Both in speaking and singing, therefore, the neck should be free from compression, and but slightly covered. The great means of improving the voice, as of all other improvements, is constant and daily practice. The professional exercises at the bar, in the senate, or in the pulpit, if properly attended to with a view to improvement, may suffice for the orator of our times; but the ancients, besides this, were in the daily practice of preparatory declamation; their rule was, after proper bodily exercise, to begin at the lowest tones of the voice and proceed gradually to the highest. They are said to have pronounced about five hundred lines in this manner, which were committed to memory in order that the exertions of the voice might be less embarrassed. The second rule has been anticipated, which is regular bodily exercise. The ancients recommended walking a certain distance before breakfast-about a mile. Riding on horseback we do not find recommended, or practised as a mere exercise,"

though Dr. Sydenham and Dr. Rush considered it as certain a cure for consumption as bark for intermittent fever.

Enough has now been said upon the subject of the exercise of the vocal organs, as a method of strengthening them. I would, however, before closing my remarks, as I am upon the subject of warding off phthisis, warn the consumptive invalid, after the disease has fairly fixed itself, against a change of climate—from a northern to a tropical one. While a very few, perhaps, have been benefited by it, thousands have found an early grave there. The debilitating effects of the climate, and the discomforts of absence from home and the endearing society of friends, have too often hurried many a victim to an untimely grave. A resort, too, to the thousand-and-one nostrums for the cure of this insidious complaint has also added myriads to the tomb. A specific remains to be found for the cure of this direful complaint, notwithstanding the vaunted eulogies of the various preparations of iodine, cod-liver oil, phosphate of lime, naphtha, &c., &c.

But to the predisposed, before the complaint has actually invaded, a resort to vocal and bodily exercise, a short summer residence at Mackinac, at Lake Superior, at the prairies of Southern Wisconsin and Northern Illinois, and especially at some of your beautiful lake-ports like Chicago, Milwaukee, &c., now that facilities for visiting those places are so great, cannot be otherwise than salubrious, as affording constant amusement for the mind and sufficient healthy exercise for the body.

DEERFIELD, MASS., Sept. 13, 1852.

ART. II.-Observations on the Various Types of Fever and Dysentery made in the Wards of the Illinois General Hospital, during the Six Months ending Sept. 25, 1852. By N. S. DAVIS, M. D., Physician to the Hospital, and Prof. of Practical Medicine and Pathology in Rush Med. College.

THE treatment of fevers and dysentery constitutes so important a part of the daily duties of the physician, that it can scarcely receive too much of our attention; and I hold it to be more especially the duty of those who occupy places in connection with public hospitals, in which greater facilities are afforded for comparative observations than in private practice, to give to the profes

sion the results of their experience. With this view I have caused accurate records to be kept, not only of each case, but of each day's prescriptions, during the whole period of my connection with the Illinois General Hospital.

During the last term of service, there were admitted and treated in the institution 41 cases of intermittent and remittent fevers; 24 of typhus and typhoid fevers; and 12 of dysentery.

Of the first class all recovered and were discharged well; of the second, 21 recovered and 3 died; and of the third, 9 recovered, 2. died and one was removed by friends before its termination either in recovery or death. It may be well to remark that most of the foregoing patients belonged to the poorer class of society, and were seldom brought to the hospital until one, two, or three weeks after the commencement of the attack.

A large majority of the intermittents were chronic cases, which had been suffered to continue until that anæmic state had supervened, marked by muscular weakness, paleness of pro-labia and tongue, sallowness of skin, and in several instances distinct enlargement of the liver or spleen, or both.

In those cases not complicated with visceral enlargements or inflammation, the treatment was generally commenced with the following prescription, viz. :

Sulph. quinine,
Pulv. opii,

15 grs.
3 grs. mix,

divide into three doses, and take one every three hours, commencing at such time that the last dose will be taken about one hour beforethe expected chill. This was generally sufficient to interrupt the paroxysms, and if so, the continuance of the sulph. quinine in doses of two grains combined with ten or fifteen grains of chloride of sodium, and given three times a-day for two or three days, and once a-day for a week longer, very certainly prevented relapse and rapidly restored the patient. Where the anæmia is well marked, I often add from three to five grains of carb. iron to each dose of the quinine and salt. In several chronic cases, where the patients. were much debilitated, the pulse soft, slow and easily compressed, and the organic actions generally sluggish or torpid; instead of giving quinine and opium, my first prescription has been sulph. quinine, 10 grs.; chloride sodium, 3jss, mix and divide into four

powders; one of which is given every three hours, at such time that the last one will be taken one hour before the expected paroxysm. This has interrupted the paroxysms in such cases with even greater certainty than the quinine and opium.

The subsequent treatment has been the same as already indicated. Where visceral congestions and enlargements exist, I generally make no other alteration in the treatment than to add to the first few doses of quinine given, from two to five grains of blue massor its equivalent of calomel, and follow it in twenty-four hours by a laxative of rhubarb and soda, or castor oil and oil of turpentir.e, and a blister over the affected organ. All active purging is. avoided; costiveness being obviated by the moderate use of the laxatives just named, or by enemas of warm water and common

salt.

Very few cases of remittent fever have come into the hospital the first three or four days after the commencement of the disease.. Where such has been the case, and the febrile exacerbations well marked the pulse full and active; the skin dry and hot; the tongue covered with a white or yellowish white fur; the head, back, and limbs painful; and all the internal secretions scanty; the treatment has been commenced by giving, at intervals of two or three hours, a powder composed of pulv. opii, from 1 gr. to 2 grs.; caIomel, 3 grs. ; sup. carb. soda, 4 grs. ; alternated with a tea-spoonful of spts. nit. dulc. After three or four of these powders have been given, the bowels are freely opened by the exhibition of castor oil, 3ss, oif turpentine, 3j, mixed. The operation of the oils is immediately followed by the exhibition of sulph. quinine and opium, in doses of four grains of the former to one or two grains of the latter; repeated every three or four hours until four doses have been taken. The immediate effect of this treatment is, to procure from the bowels two or three copious, dark, and offensive evacuations, followed by a removal of the thirst, pains in the head and back, and an increased secretion from the skin and kidneys. In recent cases, the disease is thus arrested entirely during the first 48 hours of treatment; after which the case may be treated in all respects the same as already mentioned in reference to intermittents after the paroxysms have been arrested. Beef tea or other animal broth, pretty well salted, should constitute an important po

the diet, and the bowels should be carefully regulated, if possible, without the use of active cathartics. But a large proportion of the cases of remittent fever received into the hospital, like those of intermittents, have already been sick one or two weeks, and have taken emetics or purgatives, and sometimes both.

In a large majority of these cases, I find the skin dry and harsh; the tongue red on the tip and edges, with a dry dirty fur along the middle and back part; the head and back moderately painful; the pulse quick, soft, and easily compressed; the mind often wandering during the height of the febrile exacerbation; the bowels sometimes moderately tympanitie with slight tenderness to firm pressure, or they are very flaccid and empty; the urine is scanty and high colored; the fæcal evacuations thin, dark brown, numbering from two to six in twenty-four hours; and the febrile remissions imperfect. In such cases I have occasionally found full doses of quinine and opium to operate favorably, allaying the manifest irritation of the mucous surfaces, and inducing copious diaphoresis; but in far the larger number of instances they serve only to increase the dullness and tendency to delirium, without improving any of the symptoms; while calomel and cathartics aggravate the intestinal irritation without the slightest control of the fever. During the last six months I have uniformly commenced the treatment of such cases in the following manner, viz.:

mix, give one tea-spoonful every three or four hours, with three grains sulph. quinine, added to each. If the patient does not bear well the quinine, or if the pulse be quite feeble with more frequent evacuations from the bowels, I give the emulsion without the quinine, and between each dose give fifteen or twenty grains of chloride sodium, combined with one grain of pulverized opium. This with the regular administration of animal broth for nourishment, and occasional blisters on the abdomen or chest, as the signs of local disease may indicate, generally produces a rapid improvement in all the symptoms; and by continuing the same medicine at longer