sometimes of lymph under the arachnoid. In the chest, the heart sometimes exhibited marks of disease; its vessels being peculiarly injected with blood. The lungs, in the cases of simple spotted fever, were healthy. We have seen few accounts of dissections in the pneumonic form of the disease. In some cases, ulcerations, of a peculiar character, with black, gangrenous edges, were found in the pleura of the lungs, extending deep into the substance of the organ. This appearance can hardly have existed except in the severest form of pneumonic affection. But we do not remember any description of marks of inflammation in the lungs, which did not involve the serous membrane, although, from the symptoms, it can hardly be doubted that many such cases existed. The abdominal viscera were generally healthy. The gall bladder and the urinary bladder were filled with their appropriate fluids, showing that the secretions had been carried on until death. The result of our pathological observations is, that this disease was a fever, having a peculiar tendency to run rapidly into a state of great prostration and debility, and often more or less complicated with local inflammation of an erysipelatous character.

The practice which had previously been applied to ordinary fevers, was so entirely unsuccessful in the treatment of spotted fever, that many of the practitioners on whom the management of the disease at first devolved, seem early to have lost all confidence, not only in such a course of practice, but also in the resources of professional skill and science, and for a time to have abandoned themselves and their patients to empirical experiments. A respectable writer gives the credit to a worthy matron, of the first discovery of a successful treatment. This consisted in exciting a profuse perspiration, by drinking large quantities of a decoction of the leaves and twigs of the ground hemlock, or dwarf yew, aided by a rude sort of vapor bath, made by boiling billets of wood (of the hemlock, if to be obtained), and laying them, wrapped in cloths, into bed with the patient, who was, at the same time, to be kept highly stimulated with brandy, and other diffusible stimulants. But the more judicious and scientific part of the profession were not long in adapting their treatment to the true state of the disease. Adopting a hint, perhaps, from the effects of the empirical sweating and stimulating, which soon became common, they were able to

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pursue a course of diaphoretics and stimulants, which, while it avoided the dangers of empirical excess, was eminently successful in arresting the fatal tendency of the disease. Such diaphoretics were selected, as, while they act promptly and surely, have the least tendency to induce debility. A moist heat, applied externally, added much to the efficacy of internal diaphoretics. A combination of ipecacuanha, opium, and camphor, sometimes with the addition of calomel, was much used, and with the best effects. It was necessary that a gentle diaphoresis should be constantly preserved, always with great care avoiding profuse sweating. The true measure of the use of stimulants, was the preservation of a healthful temperature and an equable pulse. In some cases, the tendency to coldness and prostration was so great, that large quantities of the most powerful kind were necessary-brandy, in hot water, tincture of cinnamon, tincture of opium, with tinctures of peppermint and lavender, were among the best; and these must be used, not so much in reference to the quantities given, as to the effects produced. Very early in the disease, almost as soon as a diaphoresis was established, tonics of a more permanent character were employed. cinchona, in its different modes of administration, was chiefly relied upon. A favorite mode of using it, by many physicians, was in a fermented decoction, with orange peel and serpentaria. A nutritious and rather stimulating liquid diet was directed also quite early in the disease.

The

Emetics were avoided, or used only when there were manifest symptoms of decided derangement of the stomach and cathartics were only used to remove costiveness, and then none but the mildest laxatives were admissible. In the pulmonic form of the disease, blisters and expectorants were added to the other means. It was sometimes necessary, on account of the cough, &c., to defer a little the use of the cinchona and other tonics; but this did not often happen, and it never appeared safe to wait for a decided convalescence before resorting to them.

This is a mere outline of the treatment adopted by a large proportion of the most successful practitioners in this singular and formidable disease. It of course admitted and required great diversity in its application to the many varieties of form and symptoms which the disease assumed in different places and in the several cases

There were a few physicians, however, who objected to such a stimulating prac tice, and insisted upon the necessity of blood-letting and other evacuants, and who still contend, that an anti-phlogistic course of treatment was the most successful. It may be said, indeed, that the prostration and debility must have been produced by some active disease, and if that disease could be arrested by early bleeding, and other means, much of the prostration would be prevented. But, however true this may be in general, in the present instance, the good effects which generally followed a judicious course of stimulants, sufficiently showed that no such disorganization was produced by the disease, which was supposed to cause the debility, as to render it unsafe to trust to them to remove it. If the bleeding recommended had failed to prevent the sinking by arresting the disease, it must have increased the exhaustion, and consequently added to the difficulty of the cure; and to perceive accurately when it would be liable to do this, would have required a nicety of discrimination greater than belongs to most practitioners of medicine, if, indeed, it can ever be attained.

The results of the treatment were very various in different places. In many places, the disease, though violent and severe, yielded to remedies with a docility truly remarkable. At the same time, it required unceasing vigilance and care to prevent fatal relapses. In such places, most of the deaths seemed to result more from accidental imprudences or neglect, than from the incurable nature of the

disease itself. In other places, the disease was speedily fatal to a large proportion of those attacked. In some small districts, twenty or thirty died in rapid succession, before any recovered. Much of this inequality is doubtless to be attributed to differences in the virulence of the epidemic itself. But there are many facts which go to show, that something must be ascribed to diversities of treatment. The comparison here intended, is not between the diaphoretic and stimulating practice on the one hand, and the antiphlogistic on the other, so much as between either of these and an awkward attempt to engraft either upon a routine of earlier days, which many men found it difficult to abandon. To our minds, the stimulating treatment, properly regulated, was incomparably preferable in its effects to the bleeding; but either was immeasurably better than the hesitating, inefficient practice to which we have alluded. If were proper to go into details, many examples might be adduced, in which a change of practice was followed b a change of results, in the same neighborhood, and often in the same families, so immediate and so striking, as to render it difficult to attribute the difference to any thing but the change of treatment.The principal treatises on spotted fever, besides various papers in the several medical journals of the time, are North on Spotted Fever; Strong on do.; a Report of a Committee of the Massachusetts Medical Society, published in the second volume of that society's communications; Gallup on the Epidemics of Vermont; and Hale on the Spotted Fever in Gardiner.