unless aided by proper remedies, the reaction was very imperfect; the coldness soon returned, with a peculiar want of action over the whole system. The surface of the body lost its peculiar elasticity, and had, in its stead, a torpid, halfoedematous, doughy feeling. Near the close of life, it was covered with a profuse perspiration. The stomach early became irritable, and rejected whatever was put into it, though without much vomiting of any thing else. The prostration increased, and was accompanied by violent pains in the back or limbs, which frequently changed from place to place, but without spasms of any kind. In many cases delirium came on very early. In most, as the strength of the patient failed, the mind became obscured, and he died comatose. In the more severe form of the disease, this comatose state followed the first attack, without any intervention of a stage of reaction: the patient became insensible, and died in a few hours. It was generally in this severe form that the spots, or petechia, appeared, which gave the name of spotted fever to the epidemic. They were not, however, confined to the more violent, or to the fatal cases, but were occasionally found in those which were comparatively mild. Neither, on the other hand, were they, by any means, general in the severer cases. In the earlier periods of the epidemic, they were much more common than towards the close of its progress. When they did appear, the spots were generally small blotches, caused by blood extravasated into the cellular membrane under the skin, of a dark purple color. In many other cases there was a slight eruption of a very different character, which scemed to be caused by the excited state of the skin, where the diaphoretic and stimulating mode of treatment was carried to a great extent.

About the beginning of the year 1812, the spotted fever first began to assume a new form, in many cases, by becoming complicated with some local inflammation. This inflammation was sometimes in the throat, producing a species of cynanche; but its more common seat was some one or more of the textures of the lungs. The fever, however, still retained the same general character as before; and in most of the places where this form of the disease prevailed, frequent cases of the more simple form were intermingled with it. The cases with inflammation were ushered in, rather more frequently than the others, with a distinct chill; and this was oftener, perhaps, followed by a

distinct reaction; but the general disease did not in these, any more than in the others, retain an inflammatory character. On the contrary, it ran speedily into a state of great depression; and when death ensued, it seemed to be less from the influence of the pulmonic symptoms, than from the violence of the general disease. There was pain in the chest, cough, and bloody expectoration; but these symptoms, although sometimes severe in the commencement of the disease, rarely retained their prominence so long as to appear to exert a very important influence upon the course of the disease, or to demand much consideration in the treatment, beyond what was necessary to give relief to the symptoms themselves. There were many other varieties in the modifications of the spotted fever, which the limits of this sketch will not permit us to notice; for it assumed a greater diversity of forms and appearances than most diseases. It was not always sudden and abrupt in its attack, as we have here described it, but sometimes crept on si lently, slowly converting a slight indisposi tion into a severe and often fatal disorder. In whatever form it appeared, however, it preserved the same general character of great prostration and debility.

Little is known of its pathological character, except what is learned by inferences from its description and history. Only a few examinations after death were made. The state of the public feeling throughout the interior of New England was much less favorable to such examinations, twenty years ago, than it is now; and the medical profession were then much less accustomed to press the impor tance of this mode of investigation than at present. Such examinations as were made, have done little to enlighten us in regard to the essential character of the disease. And had they been much more numerous, the result would probably have been no more conclusive, than that of similar observations, in respect to the nature of fever in general. The blood was found to remain fluid for some hours after death. It consequently flowed to the depending parts, giving a dark color to the skin in those parts, which was often mistaken by careless observers for putrefaction. But putrefaction did not begin early after death. The vessels of the brain, as might be expected from the comatose state which preceded most of the deaths, were found to be turgid with blood, and there was more or less effusion of serum into the ventricles, and

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

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. The 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. 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 practice, 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 it were proper to go into details, many examples might be adduced, in which a change of practice was followed by 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.