August 12th-15th. These were four days of tertian intermittent, the paryoxysms commencing about 11 A. M. on the 12th and 14th. On the well-days he took cinchona and wine.

August 16th-22d. During these seven days there was no fever, either continued or periodic. He complained only of weakness and occasional slight cough, on account of which the wine was omitted, and he took cinchona alone.

August 3d. There is no eruption on the lips. To return to duty, having been sick thirty-one days, of which there were eight of continued fever, eight of quotidian remittent, four of tertian remittent, four of tertian intermittent, and seven days of convalescence.

Remarks.-This patient had been at Grand River for some weeks, and was attacked with fever a few days after arriving at Port Colborne. Besides the treatment above mentioned, there was the daily use of purgatives or laxatives, and occasionally antimony at night. He afterwards had several attacks of quotidian and tertian ague during the time he remained in Canada.

CASE II. At Penetanguishene, Andrew B. Montgomery, aged eighteen, ship-boy, H. M. S. Experiment, was taken ill of fever on September 4, 1843.

Sept. 4th-12th. On these nine days there was constantly morbid heat of skin, with more or less of the following symptoms:great debility; headach; intolerance of light and noise; pains in the back and limbs; thirst; anorexia; and quickness and feebleness of the pulse. On the first four days there was sleeplessness, then drowsiness; there was delirium on several nights; on one or two days, green vomiting; during the night all the symptoms were aggravated; but during the whole of the day there was considerable pyrexia. The remedies were, shaving the head, cold affusion thereon, purgative medicine daily, cold sponging the limbs, and a blister to the scalp. On September 9, pain in the left umbilical region was treated by a sinapism.

To

Sept. 13th. For the first time since the 4th the heat of skin is natural, and there is no thirst, headach, or drowsiness. take a scruple of cinchona, and four grains of rhubarb twice aday.

Sept. 14th. At 8 A. M. chilly for an hour; hot for about the same time; and then sweating for an hour and a half.

Sept. 15th. Had a paroxysm rather more severe than that of yesterday.

Sept. 16th. At 7 P. M. coldness; shaking and lumbar pain till 84; hot till 10; and sweating till 12 P. M.

Sept. 17th-28th. During these twelve days there was no fever or return of the fits. He complained of weakness only, and took twice daily half-a-drachm of cinchona with a few grains of rhu

barb, and also ten or fifteen of gunpowder latterly with the morning dose only.

Sept. 29th. The complexion is of the very pale kind often seen after ague; there is no lip-eruption. To return to duty, having been ill twenty-five days, of which there were nine of continued fever, (Sept. 4th-12th); on Sept. 13th there was no fever; then three days of quotidian ague, (Sept. 14th-16th); and twelve days, (Sept. 17th-28th) of convalescence.

Remarks.-During the first nine days I watched carefully to see if there was a remission, but there was pyrexia constantly during the whole of the twenty-four hours. The patient had never before been ill of malarial fever, and has since had at the same place two attacks of quotidian and one of tertian ague. Cinchona was given only because there was a deficiency of quinine; the rhubarb was added to prevent its being rejected; the gunpowder was at first given twice daily only, but afterwards, in the morning only, as its diuretic effect was inconvenient in the night.

CASE III.-At Penetanguishene, 1843, Sept. 8, Thomas Porter, aged twenty-one, seaman, H. M. S. Experiment, complains of extreme weakness; pains in the head, loins, and limbs; catarrh; great heat of skin; pulse quick and weak; anorexia; tongue foul. Hair to be cut; cold affusion on the head; cold sponging the face and limbs. To take an emetic, to be followed some hours after by calomel and jalap.

Sept. 10th. Delirium in the night; still great weakness and heat of skin; some headach. The head to be shaved, and a blister applied; to take daily laxative medicine, and to use the antimonial solution.

Sept. 11th. Catarrhal symptoms abated; less headach; is drowsy; heat of skin, thirst, and weakness continue. To have a cathartic.

Sept. 12th. Had several stools; no headach or drowsiness; heat of skin nearly natural. To take daily, cinchona, rhubarb, and gunpowder.

Sept. 13th-19th. During these seven days he had four fits of tertian ague. On the well-days, he took cinchona.

Sept. 20th-29th. For these ten days, he complained only of debility.

Sept. 30th. Complexion very pale; no lip eruption. To return to duty, having been ill twenty-two days, of which there were five of continued fever, seven of tertian ague, and ten days of convalescence.

Remarks. This was the patient's first attack of malarial fever. He has since had repeated seizures of quotidian and tertian ague at the same station. The subjects of cases second and third had

within the previous fortnight, visited Grand River, Port Stanley, Amherstburg, and other malarious parts, and were taken ill a few days after arriving at Penetanguishene, a place where there is never seen an instance of malarial fever among those constantly residing in it, but only in persons who have previously had the disease in other parts of Canada, or have lately been in some of the unhealthy districts.

In these two cases I made some experimental use of gunpowder. In the first, its only sensible effect was on the kidneys, and, in the other, it had for some days the effect, and then seemed to act on the bowels. It is chiefly on account of its contained charcoal that gunpowder may be occasionally useful in these fevers, acting as a corrective to some disordered state of the stomach. The first dose or two is apt to be rejected. It is better to give it in the morning, as, when it acts diuretically, the patient is less disturbed in the night by calls to micturate.

Different malarial fevers.-Malarial fever includes, 1. marsh fever, and, 2. malarial fever, found where there is no marsh. The different malarial fevers of Canada, as far at least as I have observed them, may be arranged in the following manner.

MALARIAL FEVERS OF CANADA.

Family i.-Malarial continued fever.

a. Mild. b. Severe.

Family ii.-Malarial remittent fever.
1. Quotidian remittent.
2. Tertian remittent.

Family iii.—Intermittent fever.

1. Quotidian intermittent.+
2. Tertian intermittent.
3. Quartan intermittent.

Variety, Bilious remittent.

Varieties, a. Asthmatic ague. b. Incomplete ague. c. Irregular ague.

Family iv. Monoparoxysmal ague, or ague consisting of one fit only. Quartans I have found very rare. Asthmatic ague is noticed in the Edin. Med. and Surg. Journal, October 1843, p. 367. Incomplete ague is what is popularly and absurdly called "dumb ague." In it, the fits are deficient in one or two of their three stages, and pretty regular in their accession. In irregular ague, the paroxysms are complete in their parts, and variable in their accession. When a case of ague is treated with quinine before there is time for a second fit, and when none such occurs, it may be regarded as an instance of checked quotidian or tertian; but if, without medicinal interference, there be no second fit, the case

See Dr Craigie's Practice of Physic, i. 137, and Dr Dick, in Edin. Med. and Surg. Journal, January 1838. The usefulness of gunpowder, (on account of its nitre), in an important disease, is ably shown in Dr A. Henderson's paper on Scurvy in the same Journal for July 1839, and any medicinal qualities it possesses cannot be too well remembered, as in military and naval practice it is always to be obtained when medicines cannot be procured.

Edin. Med. and Surg. Journal, April 1844, page 392. VOL. LXIV. No. 164.

H

cannot with perfect correctness be called intermittent; and such cases sometimes occur, though perhaps they are too unimportant to form a separate family, and might, if not with equal correctness, still with more simplicity, be ranged with cases of irregular

ague.

Considerations on the nature of malarial continued fever. In treating cases of this disease I have carefully watched their course to see if any remission could be observed; and I satisfied myself that during the twenty-four hours, and for seven or eight. successive days, the pyrexia continued without any change, except that the morbid heat of skin and other symptoms were more severe at one time than another. It therefore seemed correct to call it a continued fever, though one cannot be equally positive as to the correctness of prefixing the term malarial to the name of the fever; as that implies the presence and operation of a specific cause. This, however, I was led to do for various reasons, and chiefly from observing the tendency of many of the cases to pass into remittent, in the same way as remittent, which is allowed to be a malarial fever, often passes into intermittent. Several objections+ may be made to the proposed theory of this disease. It may be said, 1st, that those cases of malarial continued fever which do not pass into remittent or ague are merely cases of common continued fever or of typhus; 2d, that those cases of it which do pass into remittent or intermittent are only cases of these diseases respectively, and that the febrile state dwelt on in this paper is only their stage of invasion. But to this it may be replied, that a remittent cannot well have more than two or three days' preliminary symptoms of a serious nature, and when these last for eight or ten days, there seems to be no propriety in giving them a name which certainly does not describe their character; and as for intermittent, its first stage often comes on with only a few minutes' warning; at other times a person for two days before feels uncomfortable, but still able to go about his usual employments; so that its commencement and course are different from an instance of pyrexia continued for ten days, and then passing through two fits of tertian before recovery.‡

• On the transition from one form to another, see Dr Copland's Dict. Medicine, i. page 936.

On the classification of fevers, see Dr Craigie's Pract. Physic, vol. i. page 33. In Sir William Burnett's account of the Mediterranean fever, (1816,) it is mentioned that occasionally some cases of it passed into remittent and others into intermittent, (pp. 225, 254, 478, 485.) Yellow fever assumes variously the continued and remittent types, and at times becomes intermittent. The Bulam fever is described by Sir William Pym as a continued, and by Dr Gillespie as a remittent fever. These three diseases may be considered non-contagious malarial fevers, having sometimes a continued and at other times a periodic character; yellow fever, like the others, arising from malaria, and having also an additional cause in some unknown state of the atmosphere. The mass of controversial writing on the nature of these fevers is analyzed with great perspicuity in Sir George Ballingall's Military Surgery, 1838, page 486, et seq.

Malarial continued fever is one of the kinds of that disease popularly called in Western Canada lake-fever, which name is also given to remittent, and likewise, though more rarely, to intermittent.

Having, where this paper is written, but little access to books, I am unable to refer to the works of Fergusson, Johnson, Wilson, Macwilliam, and others who have written on malarial diseases. I have endeavoured to state facts separately from hypotheses; and, in conclusion, I may remark, that since 1841 I have held these views respecting this kind of lake-fever; and for these four years have waited to see if, by further observation, they might be altered or rectified. They are now offered for the consideration and judgment of the profession, to be amended, if necessary, by other observers. Penetanguishene, Lake Huron, March 1845.

ART. V.-A Concise View of the Progress of Military Medical Literature in this Country; being a Chronological Arrangement of Authors, with Critical Remarks on their Works. By JAMES IRVING, M. D. (Continued from Vol. lxiii. p. 302.)

1782. A Treatise on the Venereal Disease. By George Renny. London, 8vo.

This work is the production of the present Director-General of the Army Medical Department for Ireland, and was published while the author was surgeon to the Athole Highlanders. Dr Renny entered the army as assistant surgeon in June 1775, was appointed surgeon in January 1780, and Director-General for Ireland in June 1795. His remarks on syphilis are evidently the result of a thorough practical knowledge and extensive experience of the disease in one of the best fields for its study. It is well known that at this time, and even considerably later, mercury was believed to be a specific; and, without its use, practitioners imagined that no case of true venereal disease was ever cured. To Dr Renny mercury still proved a difficulty, and he does not seem to have been able to divest himself of all the notions which necessarily forced themselves upon the minds of those who had been taught to take so exclusive a view of the treatment of the disorder. We now know that patients with this disease recover without mercury. Dr Renny was not then altogether prepared to make such an admission; but he administered the remedy cautiously-narrowly watching its effects —and more with the object of obtaining its alterative and diapho

In the Edinb. Med. and Surg. Journ. vol. lv. p. 348, I gave a too restricted meaning to this word, which, besides including remittent, and sometimes ague, is also applied to cases where the type is continued.