Having succeeded in subduing to a certain extent the general excitement, having relieved any local irritation that may happen to have been present, and having carried into effect the proper remedies for correcting the alvine discharges, the rest of the treatment is very simple. The antiphlogistic regimen and the use of mucilaginous drinks will at all times be proper, and unless contra-indicated by irritability of the stomach or bowels, some mild diaphoretic, such as the liq. ammon. acet. with or without a few minims of vin. ant. tart. may be given. In other instances, the common effervescing draught may be freely allowed, as it will tend to allay thirst, and will moreover prove refreshing to the feelings of the patient.

It will generally be found, that under this mode of treatment, the disease will give way, and either subside. altogether, or the remissions becoming more and more considerable, it will take on a more decidedly intermittent character. In the latter case, we may confidently have recourse to the sulphate of quinine, or perhaps in some instances, to the arsenical solution. It must nevertheless be carefully remembered, that it is by no means necessary that the disease should be reduced to one of a truly intermittent type, to justify the administration of the sulphate of quinine. On the contrary, when the disease occurs in old people, and in those of impaired constitution, it will very often not only be safe but necessary to have recourse to it as soon as we have succeeded to some extent in subduing the general excitement, and in relieving individual organs, notwithstanding the continuance of symptoms which in a common Continued fever are regarded as contra-indicating its use. Under the circumstances mentioned, a moderate heat of skin and frequency of pulse, some degree of headache and a foul, loaded, or even dry

and brown tongue, ought rather to encourage than deter us from the cautious exhibition of the drug; all these symptoms frequently being observed speedily to subside under its use, and thereby furnishing a sufficient evidence of the pathological difference between a Marsh and a common Continued fever, how much soever they may correspond in their external aspect.

Of course, should inflammation occur in any other part or organ of the body, it must be immediately attended to, and treated on common principles.

INFANTILE REMITTENT FEVER.

age,

When a child of from one to eight or ten years of has a pale, muddy, and dejected or anxious countenance; a foul tongue; a tumid belly; an irregular appetite, and a morbid state of the bowels; when it picks its nose, and is fretful and restless when awake, and whines, moans, or starts in its sleep, that child is vulgarly said to be suffering from worms. If, together with the above symptoms, the child experience occasional accessions of febrile excitement, it is in like manner said to be the subject of worm fever.

These terms, familiar to the unprofessional public, have, as usual, their foundation in correct observation, the diseased conditions alluded to, being uniformly associated with derangement of the primæ viæ, and not unfrequently with worms. By the profession, the accompanying fever has been designated Gastric, or more commonly Infantile Remittent fever.

With or without fever, the disease is one of extremely frequent occurrence, and moreover one of vast importance, in consequence of the powerful influence which greater or

less degrees of it have in modifying, or in actually inducing, a very large proportion of the disorders incident to early life.

The drooping and listlessness of the child, the muddy or pale face, the languid expression, the dark areola around the eyes, and the dilated or unsteady pupil, at once arrest the attention of the observant practitioner, who, on inquiry, is usually informed that the child, without any assignable cause, began to droop and waste in flesh; that its appetite is impaired, voracious, or capricious; that it occasionally complains of pain in its stomach or head; and that the alvine discharges are offensive and of a dark, pale, green, slate, or clay colour; that the child moans, starts, or grinds its teeth during the night; and that it picks its nose during the day. On examination, the tongue is usually found coated with a white mucus, most considerable towards the base; the belly more or less distended; and the breath nauseous or otherwise offensive.

This state of disease may continue for an indefinite period, with the effect of merely occasioning more or less emaciation and loss of healthy complexion, and may be gradually removed either by the voluntary efforts of the constitution, or by the timely interference of art.

Should these symptoms, however, be disregarded, it very often happens that the child begins to experience irregular exacerbations of febrile excitement, often leading the parents to declare that the child is at one time pale and cold, at another burnt up with fever and parched with thirst.

The febrile exacerbations vary much in their intensity, frequency, and duration. There may be one, two or even three, in the course of the twenty-four hours; that in the evening being commonly the most severe.

Each exacerbation is marked by restlessness and impatience of any disturbance; a hot and dry skin; a flush on one or both cheeks, especially in those who have a fair and delicate skin; remarkable drowsiness; some hurry of respiration; feebleness of the voice; a short hacking cough; a frequent pulse; more or less thirst; and picking of the nose, lips, tongue, or some other part of the surface: these symptoms varying both in number and degree in different cases. On the subsidence of the paroxysm, the skin cools and relaxes, but in general without much perspiration; the urine deposits a sediment; universal relief succeeds; and the child is left comparatively free from bodily suffering or mental dejection.

If, however, the disease be allowed to proceed uncontrolled, the exacerbations are liable to become more and more severe, and the remissions less distinct; the appetite is entirely lost; the thirst becomes incessant; the tongue gets dry and brown; the lips and teeth covered with a dark sticky mucus; the voice husky or suppressed; the hacking cough more distressing; delirium supervenes; and the debility and emaciation increase, till the patient sinks completely exhausted; or, symptoms of hydrocephalus supervening, coma or convulsions more abruptly close the scene.

For the convenience of description, the symptoms enumerated may, with some propriety, be divided into three groups or orders: the first, characterizing cases unattended by any febrile exacerbation whatever; the second, cases with moderate but distinct febrile exacerbations; and the third, cases of great severity, in which the exacerbations are so acute, and the remissions so imperfect, that the disease approaches the character of a Continued fever.

But, although we occasionally find these three orders of

cases regularly succeeding each other as has been described, it must be confessed that in practice, they are met with existing in various relative degrees, and apparently more or less apart from each other. Cases of the first order are most frequently met with; those of the second may succeed to the first, or the symptoms of the second may be the earliest to attract attention; whilst the third order may succeed to the first, or to the second, or the symptoms of the third may suddenly and abruptly supervene without having been preceded by either: these several varieties, as well as the intensity of each, depending upon the degree of visceral derangement present, the susceptibility of the individual, the state of the constitution, and the situation and condition of the patient at the time.

It is the more sudden and acute febrile forms of the disease that have more especially usurped the name of Infantile Remittent fever, whilst other distinctive terms have been superadded to this, according to the progress, form, and severity of particular cases. Such distinctions, however, appear to be altogether unnecessary, and perhaps tend rather to obscure than to elucidate the pathology of the complaint. It may suffice to state, that when the exacerbations are slight, the disease may last from two to six or eight weeks; that the more sudden and acute forms, under proper treatment, will generally yield in from two to four weeks; and that in almost every instance the disease yields in a gradual and comparatively slow manner, without any very appreciable crisis or critical discharge.

As already observed, it is in all its forms associated with derangement, probably of the abdominal viscera generally, but of the stomach and intestinal canal in particular. With respect to the precise or essential nature of that derangement, we are in possession of no very satisfactory informa