The skin becomes yellow during the first two hours of the attack, and remains so until death or convalescence. It is so yellow as to present in many cases a bronzed appearance.

Hiccough is another very annoying symptom. Pain in back and loins is also sometimes very troublesome.

The bowels are usually constipated, and when they begin to act the discharges are either bloody in appearance or of a thick tarry nature, very dark, never white or light-colored, showing at least an abundance of the coloring of bile. This is another important feature of the disease.

The diagnosis is never difficult, certainly not after having once seen a case. There is no confounding it with any other disease except yellow fever or jaundice.

It is different from yellow fever, because it rarely attacks persons who live in large cities. It is a country fever.

The yellow tinge is from bile, not blood. Jaundice is rarely attended with severe symptoms until it has continued for some time; and the urine, though very dark, is not bloody.

The pathology of the disease, owing to the careful observations of Michel, Osborn, Riggs, Hudson, Ghent, and other gentlemen, who have written upon the subject, is getting to be pretty well

understood.

Why the liver should be the principal gland or organ affected, I shall leave to others to explain. It is certainly one point from which the great trouble emanates. Generally the action of the liver is increased ten-fold. In fact the whole system is flooded with bile.

The blood is soon filled with the biliary elements. Quantities of bile are vomited, and the bowels are packed with it; and happily for the patient if the gall bladder does not become so clogged up with it as to prevent its escape through the ductus communis choledochus. The spleen becomes rapidly enlarged, and the kidneys, in their efforts to relieve the poisoned system, bleed sometimes profusely-rarely, however, suflicient to exhaust the patient, though Dr. Michel thinks he lost one patient from this cause alone. It generally lasts long enough to relieve the

congested kidneys, and also frequently gives temporary relief to the patient.

As I have said above, it rarely lasts longer than forty-eight hours. The urine then becoming perfectly healthy and natural in appearance until the death or recovery of the patient.

In a case reported by myself in the January number of the New Orleans Journal for 1870, the patient lived ten or twelve days after the urine became healthy in quantity and color.

In the treatment we have two poisons to contend with. First, the original malarial poison; and secondly, the poison caused by the elements of bile entering the circulation, or, according to Michel, of being retained there.

The first and most important indication is to produce free catharsis and keep the bowels moving all the time. This is an aid to the kidneys in their efforts to remove the poisonous materials from the system. If the stomach is irritable at the start, as is usually the case, calomel in a large dose is the best remedy. It will act upon the bowels, and at the same time be a sedative to the stomach. Magnesia, salts, or seidlitz powders will answer if the stomach will retain them. In a case recently under my charge I let the patient drink freely of Congress (Saratoga) water. The thirst is always intense, and water is generally vomited as soon as taken. The Saratoga water seems to be retained better than plain water, and has the advantage of keeping up a gentle action upon the bowels. Pounded ice may be allowed freely, and is of great advantage to the patient. Soda and mint water may be given to quiet the stomach, or lime water and milk, which has the double advantage of being very soothing to the stomach, and nourishing also.

Quinine of course in this, as in all other forms of malarial fever, is the sheet-anchor, and I think it always preferable in this disease to give it under the skin. You are certain of soon getting your patient under its influence, and do not increase the much to be dreaded nausea and vomiting. I have given as much as twenty-four grains hypodermically within twenty-four

hours. It is important to have as near a neutral solution of the quinine as possible.

Dr. Merriwether, a very intelligent physician of this county, has the quinine rubbed on the skin, using immense quantities in this way. He also gives spirits turpentine in teaspoonful doses, which, he says, controls the vomiting and the bloody urine. He speaks highly of his success by this method.

I think it highly important to keep the bowels moving briskly, and even during the action of medicines you will find the stools almost consistent, or at least thick and tarry; and there is rarely any improvement until the actions become thin and lightcolored.

As to the continued use of mercury, I cannot see the necessity of it. You have more bile than you can get rid of, and there is certainly no good reason for administering a remedy which is supposed to act directly by increasing the flow of bile. I think it more useful in quieting the stomach than for anything else. If the stomach can be kept quiet, the bowels moving, and quinine retained in sufficient quantities to prevent paroxysms, your patient stands a good chance to recover. But even then you may look for a large mortality, for in many cases the system seems to be so deeply poisoned as to be beyond the reach of remedies from the first. It is of the utmost importance to begin the treatment early, for if the attack has lasted for a few hours even, in a great many cases you will be unable to administer any medicine by the mouth.

Very respectfully your obedient servant,

J. S. WEATHERLY, M. D.

VICKSBURG, MISS., January 13, 1871.

Dr. Gaillard,-Dr. J. T. Davidson, of Delhi, La., called upon me this morning to examine his eyes. He states that on the 20th of November, 1870, he was attacked with malarial fever. During the first twenty-four hours after the attack he took twenty grains of calomel and about forty grains of quinine, the

latter being rejected. The stomach being very irritable, all treatment from this time until the 28th was directed to the control of that symptom-lime water with milk and the hypodermic use of morphia, and no quinine. On the evening of the 28th the attending physician commenced using quinine by enema, and that by the evening of the 30th (forty-eight hours) 400 grains had been so used; all of which was retained. Soon after the last enema, Dr. Davidson states that he "felt he was becoming blind"; that objects looked black before him, and by the following morning he was entirely blind, in which condition he remained for about seven days. After this he could see the light when the curtains were drawn aside from the window. He has slowly improved from that to this time. Now he can see to read ordinary printed matter slowly, his field of vision not embracing more than one or two words at a time. His pupils are dilated, and he is intolerant of strong light.

From the time the eyes became affected, the Doctor says he did not sleep for four days and nights.

He had had weak eyes for nine years; but at the time he was attacked with fever they were free from any inflammatory affection. P. F. WHITEHEAD, M. D.

LODORE, AMELIA COUNTY, VA.

Dr. E. S. Gaillard: Sir,-Having had occasion to use the 'exploring needle," and not having one at hand, I resorted to my hypodermic syringe. I inserted the blade into the tumor, and as I elevated the piston the pus rose readily into the cylinder. I think it the best exploring needle I ever used.

And just here let me suggest what occurred to me whilst using this little instrument-viz., that an instrument can be constructed with this kind of blade (of sufficient calibre) attached to a pump-syringe with valves that will substitute the trocar and canula, and have many advantages over that instrument. A pump made after the pattern of the pump-syringe (manufactured by the American Hard-Rubber Company) is just

the thing. The blade to fit air-tight in the end intended for the fluid when being drawn into the cylinder. In the operation of parentesis thoracis in cases of empyema this instrument will possess advantages over any other that I am acquainted with. First-The air cannot enter the thorax or abscess.

Second-No cutting is required (save the puncture). Third-Fluids can be injected into the cavity through the blade without withdrawing it.

Fourth-Fluids (such as warm water, after having been injected into the cavity) can be pumped out, thus completing this operation (paracentesis) or evacuating the contents of abscesses without withdrawing the blade.

To inject into cavities the pump must be removed and the elastic gum tube attached in its stead. By referring to the syringe alluded to above in connection with the blade of the hypodermic syringe, you will see the principle that I have endeavored to explain. There may be thousands like it, but I have not seen such. Respectfully yours,

J. A. HILLSMAN, M. D.

GREENSBORO', GA., December, 1870.

If some one has not preceded me in the discovery, you may make known through your valuable journal that I operate for tongue-tie with a narrow, curved, sharp-pointed bistoury, first elevating the tongue with the forked end of the director or other suitable instrument. I transfix the frænum just where I desire the division to extend, and cut towards the tip or outwards.

The advantages claimed are that the depth of the cut may be graduated. It is more easily performed, is more neatly done, than with scissors, and with less risk of injury or hæmorrhage. JOHN E. WALKER, M. D.

WASHINGTON, D. C., January, 1871.

The medical profession and scholars generally are aware of the ephemeral form in which most of the early American contri