But of how much greater urgency is it to rescue from his inconsistency the author who views it as the initial point of morbid action, the fons et origo of the typhoid affection-the main, it may almost be said, the only cause of fatality-certainly the chief cause of the prostration and of the tedious convalescence so common in the disease. For such an one to utterly ignore this local source and cause of danger and death, is passing strange! And yet it is precisely this which Louis does, in his record of treatment, with hardly an exception. I can scarcely call to mind a single instance in which he adapted any local measures to eradicate or obviate the local disease of the patches. So far as treatment could indicate it, the idea of disease of the elliptical patches was the merest chimera concievable. True, he applies leeches, but he finds no good place for them except about the head to obviate secondary brain complication! True, too, he resorts to the epispastic, but only upon the nuchæ, or the arm, or leg, can a suitable place be found, and then late in the disease, and with a vague idea of modifying some secondary symptom or lesion. The true seat and origin of disease, as be regards it, and as he abundantly demonstrates it by his post mortem researches, is wholly, systematically left out of view, until, forsooth, death supervened, and then we have a revelation of disorganization and destruction which he portrays for us with photographic vividness! No other adequate cause of fatality than the destructive lesions of the patches, and yet no attention, absolutely none, paid to them while under treatment! 'Tis strange, passing strange!

Theoretically then, gentlemen, this mode of treating the typhoid affection seems inconsistent and untenable. I shall relieve your patient attention when I have presented a few facts bearing upon the question at issue, and confirmatory of my position, and a few deductions and observations founded upon them.

Case 1-Called December 1st, 1865, to W. D., South Division street, male, aged 17, well developed, generally healthy and vigorous. He had complained for two or three days of headache, lassitude, etc. Found him unable to sit up from debility and dizziness; had had a partial chill and trembling; now had severe headache, though inclining to sleep, anorexia, thirst, heat of surface, pulse about 95, slight inclination to diarrhoea, pain in abdomen,

slight tenderness in right iliac region. Prescribed spts. nit. dulc. and quieting opiate. Diagnosis as to its being febricula or typhoid fever, undetermined.

Dec. 2d.-Found symptoms much the same; pulse about 100; tenderness in right iliac increased; several dejections from bowels; heat of surface and debility more marked; somnolency, anorexia, thirst considerable, Diagnosis still undetermined. Prescribed calomel grs. v, fiat pulv. ij, one to be taken three hours after the first, to be followed by seidlitz powder, dejection not being secured without; succeded by opiate.

Dec. 3.-Bowels had been acted on, with characteristic discharges. Found pulse about 100; heat, thirst, sleepiness, prostration, pain on pressure in right iliac continuing much the same, inclining to delirium and slight tympany. Exact diagnosis still in abeyance. Continued treatment.

Dec. 4.-Found pulse about 110; other symptoms much the same, though slightly aggravated; epistaxis added. The diarrhoea and pain and pressure in the right iliac continuing, became satisfied of its continuous typhoid character. Prescribed opiate, spts. nit. dulc., epispastic 4x4 in. over region of right iliac.

Dec. 5.-Found pulse about 110, still inclining to somnolence and delirium; other symptoms not materially different; blister had just drawn. Diagnosis confirmed. Continued treatment.

Dec. 6.-Found him more easily aroused and clearer in bis mind. Pulse 105; diarrhoea, thirst, heat, abdominal pain, slightly less. Continued treatment.

Dec. 7.-Found all symptoms slightly abated. Pulse about 95; diarrhoea under control; mind clearer; more tolerance of pressure in right iliac; debility and heat less marked; slight desire for food. Continued treatment superadding two grs. of sulph. quinia every four hours.

Dec. 8.-Symptoms not greatly less, but all in that direction. Pressure over Peyerian patches better borne, though still slightly painful. Continued treatment.

Dec. 9.-Symptoms improved in every respect; culmination apparently reached.

Dec. 11.-Convalescence has continued without interruption. Local symptoms in right iliac hardly noticeable, and so on (not to

dwell) gradually though steadily till well. Attendance discontinued on 16th.

My impression from the ensemble of the symptoms, was and is, that it would have been a case of grave, protracted, and perhaps fatal typhoid affection, but for the abortive treatment by the epispastic, etc.

Case 2-Called September 29, 1866, to Mrs. C. P., Perry street, aged about 24, spare, though vigorous. She had had prodromous symptoms, ending in chill, for three or four days previous, keeping about house. I found pulse about 85; anorexia complete; tongue slightly furred and dryish; frontal headache severe and continuous; thirst and lassitude extreme; abdominal pain severest on pressure over right iliac region; manifested great anxiety, etc. Prescribed quieting opiate and spts, nit. dulc. every four hours.

Sept. 30.-Symptoms not greatly varied, though all in the direction of increase; heat of surface marked and unintermitted; bowels inclining to looseness. Full diagnosis in abeyance. Continued treatment.

Oct. 1.-Symptoms slightly aggravated; pulse about 95; headache severe; prostration extreme, inclining to faintness; great intolerance to pressure ovcr right iliac; slight diarrhoea. Prescribed calomel grs. iii, in three hours the same; movement of bowels to be followed by opiate, every four hours.

Oct. 2.-Symptoms aggravating; pulse 110; anxiety changed to hebetude, though conscious of headache and abdominal pain, especially on pressure in right iliac. Becoming confirmed in opinion that she had incipient typhoid affection, prescribed continued treatment, and added epispastic over right iliac.

Oct. 3.-Symptoms not greatly changed, though in the direction of aggravation. Pulse about 105; somnolency and debility increasing; blister had not fully drawn, so continued it and other treatment.

Oct. 4.-Blister complete; symptoms not very different, though with less of abdominal pain and fewer dejections. Continued treatment.

Oct. 5.-Symptoms continued much as before, with slight increase of drowsiness. Continued treatment.

Oct. 6. Symptoms continuing and of deepening tendency, from

increased hebetude; complained less of pain of head and abdomen; still, as blistered surface would now admit of pressure upon it, found considerable tenderness over right iliac with some meteorism. Satisfied that the disease of the patches, though checked, was not adequately subdued, I direeted repetition of blister and continued treatment.

Oct. 7.-Blister well drawn; symptoms not greatly changed-certainly not aggravated; pulse four or five less.

Oct. 8.-Symptoms generally mitigated; pulse 100; heat and thirst less; diarrhoea checked; hebetude somewhat abated; pain not mentioned; more competent and disposed to muscular exertion. Continued treatment.

Oct. 9.-Symptoms still in the direction of improvement. As the seat of the blister would now admit of pressure, found less of tenderness and meteorism. In brief, the disease had culminated, and convalescence was established, and continued very slowly, though very steadily to complete restoration. Attendance was continued five or six days from this date, but with no anxiety or doubt as to the result, so that giving the daily record is superfluous.

Case 3.-Was called November 3, 1866, to Mrs. V. C. N., Tenth street, aged about 38, of fleshy, full habit, and general good health. She had been ill a few days, though about the house. Found her unable to sit up from debility and dizziness. Pulse about 98; had vomited; had headache, anorexia, thirst, abdominal pain, with great intolerance of pressure in right iliac region, great mental agitation, several liquid dejections, etc., etc.

But, in order to abbreviate my paper, rather than give the daily record, I will concisely say, that the history of this case and of its treatment was nearly a repetition of case two, excepting that I applied the epispastic some day and a half earlier, and had a corresponding abatement of urgent symptoms and culmination of the disease, and also obviated the necessity of the second epispastic. If my diagnosis in these cases is open to question, I can only say that they (especially Nos. 1 and 2) lacked few, if any, of the characteristic symptoms of the early stages of the disease. Of course the lenticular rose spots, the sudamina, the severe brain and nerve symptoms, etc., were not present, because, according to

Louis and Flint, they are incident to later stages of the affection. The eruption rarely appearing sooner than the second week, and the sudamina and severe brain and other complications at a still later period, and all of these and all of the other symptoms are of ever varying degree, even when existing, which none of them always are. They are all secondary to and symptomatic of, the one primary affection, requiring the kindling of morbid sympathies and the absorption of morbid products of the diseased patches, with the accompanying highly fermentative febrile movement for their development and dissemination.

I do not need to be reminded, gentlemen, that neither one swallow, nor three swallows makes a summer. Neither can three cases settle a disputed question of treatment. I only claim that in these cases the disease, whatever it was, was aborted by the thorough application of epispastics, inasmuch as the affection showed not the slightest indication of abatement until this measure was adopted, but a marked abatement immediately thereupon.

To my own mind they serve as strongly confirmatory of Dr. Louis' view of the affection, that it is primarily and essentially a disease of the Peyerian patches. But even upon the supposition that this affection is only one of the symptoms of an essential fever, yet, with the concession that it is one of the earliest symptoms, and always indicates the seat of the gravest lesion, and therefore the source of the greatest peril, it seems to me to clearly fulfill the most urgent indication, and by consequence to be the most rational and consistent treatment.

Is the objection raised that it sometimes occurs in this affection that the indication of pain in the right iliac, even by pressure, is slightly or wholly wanting; yet, according to Louis, predicating the affection to be typhoid fever, the incipient disease is none the less there, though latent, masked and undemonstrative. And if there, I would like to make Louis consistent with himself, by treating it according to its nature and seat.

It perhaps ought to be said, in extenuation of the practice of Louis and others, that, being cases in hospital, and therefore generally coming in hand with the disease fully established and often well advanced, recourse could not be had to abortive treatment with hope of success.

But in this class of cases, with the evidence