er of hastening or suspending it to a certain extent. *

their better preparation. As digestion commences and proceeds and the stomach contracts, the chyme or more altered parts are propelled to the pylorus, and the least prepared or least soluble parts are thereby placed nearer the cardia, whence they are simply regurgitated and remasticated, or where they occasion, according to the states of the organ, or the states of their preparation in the mouth, or their nature, if not rumination, partial or complete, acrid eructations or cardialgia, or any other form of indigestion.

16. Dissections have not thrown any light on this affection. Nor can it be expected that, even in the event of sudden death taking place in a ruminating subject, any very manifest alteration of structure would be found. FABRICIUs and BARTHOLINUS were confident of finding two stomachs at least in ruminating persons, from the analogy of the cornuted animals! PYER and MORGAGNI justly ridiculed the idea, and argued that there were animals which ruminated without a double stomach. The first instance in which inspection after death was made was in the case of the monk already alluded to. It was made by FRANCIS PLAZZONI, and is related by RHODIUS and BONET, the former of whom states: "Monachus cum voluptate cibum ruminavit. Medici brutorum more genuino ventriculo præditum putabant. Ipso defuncto, F. PLAZZONUS œsophagum reperit undiquaque carnosum instar musculi, reliquis universi corporis partibus se recte habentibus." The physicians of the seventeenth century were not much enlightened by the opening of this monk, but their dreams of the existence of two stomachs were henceforth dissipated. J. P. FRANK mentions the case of an old hypochon-pendix (Form 558). These were aided by warm driacal pharmaceutist who ruminated for forty salt-water bathing, followed by frictions of the years. He died greatly emaciated, and on dis- surface; by cold sea-bathing, or the cold showsection the pancreas was found scirrhous. In er-bath; by attention to diet, by eating in moda case noticed by BONET, the only change ob-eration, and by masticating deliberately. In served after death was the very great size of the stomach and the rough or corrugated state of its villous surface.

18. IV. TREATMENT.--This affection should be treated simply as a form of indigestion, due attention being paid to the state of the biliary secretions, and, indeed, to all the secretions and excretions. But the means of cure will frequently fail if the patient neglect to take his meals deliberately, and masticate his food sufficiently, or if he take more than his digestive powers can duly dispose of. In the cases which occurred in my practice, a grain of ipecacuanha, with a sufficient quantity of the pilula aloës cum myrrhâ, or of the extractum aloës purif., to preserve the bowels open, was given twice daily, and a tonic draught about an hour before dinner; or only the pills prescribed in the Ap

other respects, and according to the associations which this affection may present in practice, the treatment is altogether the same as is recommended in the article INDIGESTION.*

17. III. CAUSES. The predisposing causes of this affection in man are manifestly debility of BIBLIOG. AND REFER.-Fabricius ab Aquapendente, Op. the stomach with increased organic sensibility, Anat. Physiol., Pars ii., p. 137.-J. Burgower, Dissert. de and an insufficient secretion of the gastric Ruminatione humana. Basil, 1626.-Horstius, Opera, t. ii., p. 162, 167.-Cœlius Rhodiginus, Antig. Lect., 1. xi., cap. juices for the quantity and state of the ingesta. 16.-Delrio, Disquit. Mag., 1. ii., quæst. 14.—Rhodius, Cent The exciting cause is manifestly an imperfectly ii., obs. 59.-Genathius, Dissert., De. vii., No. 3.-Salmutis, divided and insufficiently masticated and insal- Cenc. i., obs. 100.-T. Bartholinus, De Unicornu, cap. i.; ivated condition of the more solid food, togeth- cap. 6, p. 62, 220.-D. Sennert, Med. Pract. 1. iii., p. i., sec et Anatom. Hist., cent. i., No. 39.-Peyer, Merycologia, 1. f., er with a too rapid distention of the stomach. 11.-J. F. Lynceus, Exposit. Histor. Nardi Antonii Recchi, Probably the former would be insufficient to p. 630.-G. H. Nelschius, Observat. Med., Episag. xxxvi.~ excite the affection without the latter, otherD. Ludovicus, in Ephimerides Nat. Curios., Decur. i., Anno ix. and x., Observ. 160.-Slare, in Philosoph. Transac., wise the numerous persons who are incapable No. 193.-Schurig, Chylologia, p. 381.-Bauhinus, De Hersufficiently to masticate their food, owing to maphroditis, 1. i., cap. 10.-Berner, Eger Ruminans cum the state or the want of their teeth, would be Asthmate Hypoch., &c. Hala, 1709.-Bonet, Sepulchremuch more liable to this disorder than we find Phys., cent. v., No. 38.-Morgagni, De Sed. et Caus. Morb., tum, &c., 1. iii., 1. v., obs. 9-10.— Blankard, Collect. Med. to be the case. It is not unlikely that more de- epist. xxix., art 4.-Ackord, Diss. de Ruminatione Humapends upon the state of the organic sensibility na, Singulari Casu illustrata. Hale, 1783.-Sauvages, Noand contractility of the stomach, especially at solog. Methodica, vol. ii., p. 339.-Goldhagen, Diss. de Rumin. Hum. Hala, 1783; in Doering's Tracts, vol. i., p. 100. its cardiac opening, than upon the other con-Meyer, Dissert. de Rum. Hum. Erl., 1792.-Buxto, Disditions singly now mentioned. It is most prob- sert. enarrans Ruminationis humanæ Casum. Goetf., n., able that, as the more digested and digestible 1802.-J. P. Frank, De Curandis Hominum Morbis, 1. v., matters are propelled towards the pylorus, the fahrungen, No. iii.-Roubien, in Journ. de Med. Contin., t. pars ii., p. 551.-Vogel, Anthropologische und Medic. Erleast divided or masticated aliments irritate xiii., p. 361.-Et Annales de Méd. de Montpellier, 1807.the cardia, and thus, by a reflex action, origin-Hegewisch, in Horn, Archiv., Sept., 1809, p. 107.-Tarbes, ating in the stomach, or rather in this region Journ. Génér. de Médecine, No. 286.—Percy et Laurent, in of the stomach only, regurgitate or propel a portion of the unmasticated contents upward and along the œsophagus to the mouth, for

* [Three cases of this rare affection have come under our knowledge, one of which was connected with a sacculated oesophagus. The others corresponded exactly with the cases above described, the food having been returned to the mouth a short time after eating, when it was remasticated and reswallowed without farther difficulty. The habit, for it was partly, at least, a voluntary act, seemed to have been brought on, in both cases, by swal lowing the food hastily and without chewing. There was no cardialgia or nausea, nor was there any gastrodynia in either case.]

*SAUVAGES adduces an interesting case of human rumination which occurred in a rustic, who accelerated and promoted the ruminating process, or, rather, the regurgi. tation of his food for remastication, by pressure over the stomach. After thus promoting at will this process, and resorting to it for several years without any detriment to his health, his confessor admonished him against it. But rumination continuing, notwithstanding the means employed to promote it were laid aside, he was told to reject the regurgitated food. He did so for a fortnight, but he became so debilitated that he had recourse to medical aid. His physician advised him to instantly re-swallow the substances which were regurgitated, without submitting them to a second mastication, and prescribed for him tonics, stomachics, and aperients, and after a few days he was freed from his rumination and all his ailments.

Dict. des Sciences Médicales, t. xxxii., p. 526, 8vo. Paris, 1829.-Toggia, Della Ruminazione e Digestione dei Ruminante, 8vo. Torino, 1819.-J. Copland, History of a Case of Human Rumination, with an inquiry into the na ture of the process, and into some of the Phenomena of Digestion; and with an historical relation of similar affections, in Lond. Med. and Physical Journ., vol. xlv., p. 362, 8vo, 1821.-L. J. Schmidtmann, Summa Observationum Medicarum ex Praxi Clinica Triginta Annorum deprom tarum, &c., vol. iii, cap. viii.. p. 182. Berol., 1826.-M. Riche, in Archives Génér. de Médecine, t. xvii., p. 266. RUPIA. SYNON.-Ulcus atonicum, Ecphlysis Rhypia (Good). Rhyparia; Rupia (from púTos, filth). Phlyzacia, Alibert. Atonic ulcer. CLASSIF.-Order 6th. Vesicular eruptions. Genus 4th. Offensive vesicular eruption (Willan and Bateman). IV. CLASS, IV. ORDER (Author).

cilitate its removal. When it is removed, the surface underneath the scab appears ulcerated more or less in extent and depth. If the part remain exposed to the air, either a new crust or scab is formed, or ulceration extends more deeply and spreads until it approaches the breadth of a half-crown or crown-piece. The ulcerated surface is pale and readily bleeds. The atonic ulcers thus produced heal very slowly; and the cicatrices which they leave retain for a long time a brownish livid hue, and are liable to break open afresh.

5. iii. Rupia escharotica occurs chiefly in cachectic children and infants, and occasionally in aged persons, or in adults who have suffered severely from chronic rheumatism or consti1. DEFIN.—An eruption of small, flattened, and tutional syphilis. It commonly appears on the distinct bullæ, surrounded by inflamed areolæ, fill-legs, the thighs, the scrotum, the abdomen, the ed with a serous, puriform, sanious, or dark bloody fluid, and followed by thick, prominent, dark-coloured scabs, covering unhealthy ulcers.

2. I. DESCRIPTION.-This eruption is observed chiefly in delicate, debilitated, or cachectic constitutions. It is so closely allied to Pemphigus as to justify the arrangement of both as species of the same genus. Most of the recent writers on diseases of the skin have described three varieties of rupia, namely, R. simplex, R. prominens, and R. escharotica.

upper part of the chest and neck, but it rarely is seen on the upper extremities. This variety, in infants, is almost, if not altogether, identical with pemphigus infantilus (see PEMPHIGUS, ◊ 9). It begins by one or two red and livid spots, over which the cuticle is soon raised, by the effusion underneath it, of a serous or sero-sanguinolent fluid. The bullæ thus formed go on increasing in an irregular manner; the serum they contain becomes turbid, and of a blackish hue; they afterward break, and the dermis, left exposed, appears ulcerated, softened or gangrenous in different points. A bloody and an offensive sanies bathes the surface of the sore, the edges of which are livid, but not very painful. In infants the bullæ do not generally reach so large a size as those in adults, but they follow each other in greater numbers; the sores becoming painful, causing fever and sleeplessness, and even fatal exhaustion in the course of two or three weeks. In adults, this variety sometimes acquire the dimensions of rupia prominens, and small portions of skin and cellular substance often sphacelate, and are detached slowly from the ulcerated surfaces. In every instance cicatrization is tardy, restoration being often arrested or stationary for a time. This variety is always attended by mark

3. i. Rupia simplex commonly appears on the legs, sometimes on the loins or thighs, and seldom on other parts. It commences with one or more flattened, isolated bullæ, varying from the size of a sixpence to that of a shilling, that contain at first a transparent serous fluid, which soon becomes turbid and purulent. This fluid grows consistent, and is finally changed into scabs of a chocolate colour, thicker in their centres than in their circumferences, the outer layer being continuous with the epidermis, which appears detached at the margins by the fluid underneath. Under the scabs, which are detached within a few days, the skin is found excoriated or ulcerated superficially. The sore, if left to itself, either heals up, or is more frequently covered by another scab, which is thrown off at a later period; and thus the pro-ed constitutional disturbance. cess may be repeated for several times. When the ulcer heals, the part retains, for a very long time, a livid or deep red hue.

4. ii. Rupia prominens presents larger bullæ than the preceding, and the scales are thicker, and the ulceration underneath is deeper. Each bulla is preceded by a circular red spot, over which the cuticle is detached and slowly raised by a dark thick fluid, which soon concretes into a scab, the thickness and size of which increase for some days afterward. The circumference of the scab is surrounded by a reddish border, a few lines in breadth, the epidermis of which is raised by a serous fluid, which forms a new incrustation, adding to the extent of that already produced. The areola also increases in breadth around the base of the scab, which itself increases in breadth and thickness during three or four, or even during seven or eight days. When the diameter of the scale is large it resembles the outer surface of the convex shell of an oyster; but in this variety the incrustation projects in the same degree as it spreads, becomes conical, and resembles the shell of a limpet. The scab adheres firmly, and generally requires emollient applications to fa

6. Rupia is sometimes complicated. R. simplex is frequently associated with ecthyma, or with scabies. The other varieties are occasionally complicated with purpura, or with the cachexia produced by very chronic rheumatism, by constitutional syphilis, and by long-neglected disorder of the digestive, assimilating, and excreting organs.

7. II. DIAGNOSIS.-Rupia can be confounded only with ecthyma and pemphigus. (a) Ecthyma differs from rupia in being a pustular eruption from its first appearance. The highly inflamed areola surrounding the pustules, and the hardness, small size, the embedded position, and the closer adherence of the scabs, farther distinguish ecthyma.-(b) Rupia is distinguished from pemphigus by the smaller size and flatness of the bulla; by the turbid and sanguinolent contents, as contrasted with the usually limpid and transparent fluid of pemphigus; by the thick, rugous, and imbricated scabs; and by the ulcerations of various extent and depth.

8. III. CAUSES.-Scrofulous children, the offspring of debilitated, drunken, or dissipated parents, and persons who have been weakened or exhausted by depressing causes, by sickness,

and unwholesome food, are the most frequently | by confined underneath or around the scab perthe subjects of this eruption. It appears, es- petuates the irritation, and the healing process pecially during the winter, among the insuffi- is prevented. Hence the necessity of having ciently clothed and fed, and among those who recourse to such applications as will at the neglect personal cleanliness, and who live in same time exclude the air and restore the low cellars, or in close, crowded, and ill-venti- healthy state of the parts. The water-dresslated places or apartments. It is also liable to ing, by excluding the air, is beneficial, as well occur during convalescence from small-pox, as by allowing the immediate escape of the irscarlatina, measles, &c.; and in both young ritating secretion from the surface of the sore; and aged, who are the subjects of some degree but it does not restore the tone of the affected of some anæmia in connexion with impaired vessels. Strappings, insinglass plasters, and excretion. Its association with cachexia, es- similar means, does not allow the escape of the pecially as an effect of this state of the frame, irritating secretion, and hence,.if not often reand of constitutional syphilis, in some other in-newed, they fail of being of service; but when stances, is a circumstance of great importance in forming our intentions, and in selecting our means of cure.

9. IV. PROGNOSIS.-Rupia is not in itself a dangerous, although often an obstinate, and, when the eruption is abundant, a serious disease. When it appears on the legs, the ulcers are always intractable. The duration of rupia cannot be stated with precision; but it is always chronic, and often very protracted; much, however, depends upon the age and constitution of the patient; the number, the size, and the situation of the bullæ; on the states of the consequent sores; upon the character and amount of the constitutional disorder; or of the cachectic taint, or of existing visceral disease when this is present.

10. V. TREATMENT.-The intentions of cure are first to improve the state of constitutional power by suitable diet, regimen, and medicines; and next to improve the state of the ulcerated parts.--(a) The various remote causes should be removed, and the excreting functions of the skin and the assimilating actions promoted by means of warm, or warm salt-water, or alkaline baths; by a generous, nutritious, and digestible diet; by a fresh, dry air; by tonic decoctions or infusions, as those of cinchona, cascarilla, gentian, absinthium, &c., with alkalies, or with the nitro-muriatic acids; and by the preparations of iron, when indications of anæmia are observed. But while these objects are pursued, the alvine secretions and excretions ought to be promoted by stomachic aperients; or by a combination of mild purgatives with tonics, or vegetable bitters, or other restoratives. If these means should fail, a course of the cod-liver oil should be prescribed, as I have lately found it successful in two obstinate cases. When this eruption appears in children, the health and state of the milk of the nurse require attention. A healthy nurse should be selected for the child, and change of air recommended if this may be accomplished. When rupia occurs during or after weaning, a nutritious and wholesome diet should be prescribed, and asses' milk, diluted, or fresh whey allowed for drink; but change of air, especially to a dry and open situation, or to the sea-coast, ought to be most strenuously insisted upon.

frequently renewed, after the parts are stimulated by suitable application, they are then very beneficial. Lotions containing the nitrate of silver, or nitric acid, or the bichloride of mercury, or tincture of iodine, or the sulphate of zinc, or alum; or sponging the surface with spirits of turpentine; or ointments containing either of the balsams, especially the balsam of Peru, or one of the turpentines, are generally of service. BIETT recommends an ointment containing the proto-ioduret of mercury (3j. to an ounce), or deuto-ioduret (gs. xii. to 3j.). RAYER advises the surface of the ulcers to be dusted with cream of tartar. A cretaceous powder, containing the oxide of zinc, is preferable to this. An ointment consisting of one third or a half part of the unguent. hydrarg. oxido nitricum is often of service.

BIBLIOG. AND REFER-Lorry, De Morbis Cut., p. 76.S. Plumbe, A Pract. Treatise on Diseases of the Skin, 8vo. Lond., 1824, p. 156.-A. Cazenave, in Dict. de Méd., 2d edit., art. Rupia. See the Bibliography and References to the article PEMPHIGUS. [See Am. ed. of Cazenave on the Skin, with Notes, by H. D. Bulkeley, M.D.] SALIVATION.-See Mercurial Salivation, and other forms of Salivation in art. Poisons, 580, et seq. SCABIES.-See ITCH.. SCARLATINA RHEUMATICA.—SYNON.Febris Exanthematica articularis; Exanthesis Arthrosia; Plantaria; Dengue; Demga; Febris peculiaris epidemica; Giraffe, Bouquet, Fr. Dandy; Eruptive articular fever; Epidemic eruptive rheumatism, Cock. Epidemic anomalous disease, Stedman. Peculiar epidemic fever.

CLASSIF.-III. CLASS, III. ORDER (Author). 1. DEFIN.-Severe pain commencing suddenly in the small joints, followed by local swellings and chilliness, or shiverings; to these succeed heat of skin, intense pain in the head and eyeballs, which soon become general; and on the third or fourth day a scarlet efflorescence appears on the palms of the hands, spreads rapidly over the body, and continues two or three days, after which the symptoms subside, the malady being infectious and epidemic. 2. The epidemic fever, which has been variously named, but which may be justly called an eruptive articular fever, or eruptive arthritic fever, has been somewhat differently described, and probably it has presented modifications with 11. (b) The local treatment of rupia consists the climate, season, locality, and circumstances chiefly of puncturing the bullæ early, and allow- in which it appeared, and with the treatment ing the morbid secretion to escape, and of hav-prescribed for it. But wherever it has occuring recourse to such applications as will ex-red it has prevailed almost universally, few perclude the air and restore the healthy action and sons having been exempt from it. It has in evtone of the vessels of the part. When the scab ery place, however, presented distinct characis formed over the sore, with the natural inten- ters, which constitute it a disease sui generis— tion of protecting diseased surface from the ac- different from others, in combining an exantion of the air, then the morbid secretion there-thematous eruption, ushered in by fever, with

III.

46

most severe rheumatic or neuralgic symptoms in different cases. Usually a person in perfect -the course of the malady being so divided by health was suddenly affected with stiffness and intervals or remissions as often to give rise to pain in one finger, commonly the little finger. the idea of relapses having been a common feat The stiffness and pain increased and extended ure in its progress. The first account of its up the hand, along the arm to the shoulder. existence was brought from Rangoon in the The fingers of both hands became swollen, stiff, East Indies, in May, 1824, and it appeared in and very painful, and incapable of being bent. Calcutta in June. It extended in various di- Sometimes the affection commenced in the rections to the different presidencies. Dr. Mou- lower extremities, always in the small joints, AT states that it prevailed not only in Berham- and extending to the large, and to the trunk. pore, but in many other places in the vicinity, These symptoms were followed in a short time in March, April, and May, 1825. The secretary by restlessness, depression of spirits, by nausea, of the Medical and Physical Society in Calcutta in some cases by vomiting, and by chilliness or says that it was particularly severe in the popu- shivering. But Dr. DICKSON States that shivlous towns of Patna, Benares, Chunarghur, and ering was either slight or wanting in the disnumerous other places. Dr. MoUAT describes ease, as it prevailed in Charleston. To these it as "an epidemic fever," which was charac- succeeded fever, with great heat of skin, interized by the suddenness of its attack, the tense headache, acute pain in the back, knees, redness and watering of the eyes, the acute ankles, and in every joint, with violent pain in pain in all the joints, rendered excruciating on the eyeballs, which felt to the patient as too the slightest touch, the scarlet or crimson ef- large for their sockets. In some cases, while florescence on the surface, and its sparing nei-the extremities were cold at first, the rest of ther age, sex, nor habit of body." The ac- the body was intensely hot. As the fever and counts furnished by the East Indian physicians heat of skin were developed, the whole body, of the symptoms and treatment of this epidem- particularly the head, eyes, back, and joints, ic fever agree in the essential characters, but was racked with pain. In some the features are desultory and very imperfect in many re- were swollen and distorted, especially the eyespects, and are mixed up with speculations, as lids; in others, with swelling of the face and usual, as to the influence of too much rain or of distortion of the fingers, soreness of the mouth, too little rain, of electrical conditions, of terres- or ptyalism occurred. Patients often complaintrial emanations, and of other supposititious ed in this stage, as well as in those which folcauses in producing it, while the most obvious lowed, of a feeling of great cold, even when the and true cause is entirely overlooked. The skin was very hot to the touch. When Dr. physicians who have written from their experi- STEDMAN had the disease, he covered himself ence of the epidemic in the West Indies and with three blankets, although the weather was North America, two years after the prevalence sultry at the time. The severe pains, restlessof it in the East, have given the fullest account ness, and nausea rendered this stage the most of its symptoms and treatment, but without distressing of any form of fever excepting rheubeing acquainted with its previous appearance matic fever. These symptoms generally conin the East Indies. tinued with more or less severity for twenty3. This disease made its appearance in the four or thirty-six hours. The fever then abated, Island of St. Thomas, in the West Indies, in and with it also the pains. The patient, howSeptember, 1827, and soon extended to the rest ever, continued in a state of languor, irritabiliof these islands and to the southern states of ty, and restlessness for three days, but without America. It advanced westward among the fever; and generally without hunger, thirst, islands during the winter, and spread to the and altogether without taste, the tongue being ports on the Gulf of Mexico. Thence it trav-loaded, and the mouth presenting small aphelled northward, and reached New Orleans in the ensuing spring. During the summer Savannah and Charleston were severely visited by it. A few cases of it appeared in Philadelphia and New York; but it did not extend farther north. It has been described by the several writers referred to hereafter, but with much difference in many particulars; and it does not clearly appear whether or no the difference was owing to the influence of climate and locality, or to the treatment adopted by the writers. Dr. STEDMAN, who practised in the Island of St. Thomas, where it first appeared, and Dr. DICKSON of Charleston, have given good descriptions of it. The former states that, of a population of 12,000 in the principal town of St. Thomas, scarcely one escaped. It appeared so suddenly, and spread so rapidly, as to have caused great alarm; but it soon was discovered that although a most painful, it was not a dangerous malady; yet it often left much suffering, and even disease, after the decline of the more severe symptoms.

4. I. DESCRIPTION.—Dr. STEDMAN divides the course of the disease into three stages. (a) In the first, the invasion was somewhat different

thous sores. The pulse was in this stage much accelerated, the urine high coloured, and the bowels confined.

5. (b) The second or eruptive stage commenced the third or fourth day after the primary fever, generally the third, with a return of fever, and with an efflorescence which appeared on the hands and feet, and rapidly spread over the body. This eruption is differently described, both as to its characters and time of appearance, and probably it was modified in different cases; but in this, as in other respects, the descriptions are loose, devoid of scientific precision, and by no means creditable to the writers. Dr. STEDMAN describes the eruption as that of "a blotch or wheal of red-coloured skin, between that of scarlet fever and that of measles." Others state the eruption to resemble that of scarlet fever; others that of measles ; some that of roseola or erythema; and some the nettle-rash. It was attended," in the severer cases, by swelling of the feet, hands, and face, particularly the eyelids, and by a distressing tingling, which, as the eruption disappeared, became an intense itching. The efflorescence generally began to fade on the second day, and

was entirely gone before the third morning of a thick crop of pimples was the first token of its existence. This was followed in almost ev-disorder. On the third or fourth day, little or ery case by some degree of desquamation," no fever being present, the tongue became coatwhich, in a few instances, gave rise to trouble-ed with a yellowish fur; the stomach uneasy some consequences. After this eruptive stage, many patients began to recover their spirits and strength, a complete want of taste often remaining for some days; but many patients also became subject to the next stage.

hands swelling with thickening and numbness. There were much itching and burning of the skin, and at this period a second febrile paroxysm often came on; and the pains of the joints were in many aggravated to their former severity." In some cases the first stage of the disease had passed over with very litle notice or complaint, and yet in them this eruptive or second stage was very violent. Many became sensible, on the third or fourth day, of an inflammation and enlargement of the glands in the groin, axilla, neck, &c., and these glands continued swollen and painful a long time after convalescence was established.

or distressed; the patient low-spirited, impatient, fretful, and restless at night. Frequently there were great lassitude and debility, nausea, vomiting, and a distressing feeling of oppression. About the sixth day of the disease "these 6. (c) The third, or rheumatic stage, sometimes symptoms were more or less relieved by the immediately followed the eruptive stage, but coming out of an abundant eruption, which must often not until one, two, three, or four weeks, be regarded as an essential or characteristic or more had elapsed; and however early or part of the malady. It consisted of irregularlylate it appeared, it was generally of consider-shaped patches, red and elevated; the feet and able duration, the pains and paralysis being greater than at first. "These pains were not accompanied with fever; and they generally fixed themselves in one or two joints, and continued to excruciate the patient for weeks." They were always severest in the morning, and wore off in some degree towards evening. Some were tormented, in addition, by most distressing itching of the skin; and in others the joints, particularly those of the fingers, were painful, stiff, and swollen so as to produce deformity. The secondary pains were chiefly in the fingers, toes, wrists, ankles, and knees; confined persons to their beds, and were so aggravated, on motion, as to call forth groans and shrieks from those who suffered this stage severely. Except these pains, and the irritation they occasioned, "no other symptom of disease remained; the appetite was good, although the sense of taste was blunted." "In a period varying from three to four, or six days, the pains began gradually to subside, deserting one jointed. Below five years of age convulsions very after another until they remained fixed for some time in one. This process occupied several weeks, and was often attended by relapses." This description, however, applies only to the severest form of the malady, endless grades of severity, as well as differences in the stages, having been observed; "for while some, who underwent the primary fever with the utmost mildness, had the eruptive attack with great violence, others, who had passed gently through both, and were congratulating themselves on their escape, were suddenly crippled by the secondary pains." It was remarked that those whose unavoidable occupations forced them to exertion, or who had resolution enough to exert themselves, got sooner rid of the pains than those who gave way to them.

8. Very young children were liable to the disease, even from a few days after birth: some were supposed to be born with it. In these the skin was of a scarlet red, and the tongue and lips smooth and fiery. The infant could not bear to be disturbed; it screamed violently when lifted or when any of its limbs were mov

commonly attended the invasion, and sometimes continued with great frequency throughout the whole of the attack. Pregnant women were very liable to abortion, instances of miscarriage having been numerous. They were usually seized at the very commencement with violent pains in the back and loins, extending into the thighs, occasioning the expulsion of the fœtus. In old persons the disease occasioned excessive prostration of strength; and in several of these it left behind it an erysipelatous inflammation of one or both legs. There was often soreness of the mouth; looseness, lividness, and sponginess of the gums, with slight salivation. Ulcers sometimes formed in the mouth, which were occasionally painful, irritable, and difficult to heal. Very few died in Charleston; but the aged, the intemperate, and corpulent were severely shaken by the malady, and remained long debilitated and emaciated; few persons above the age of sixty had absolutely recovered from it after two or three months from the attack.

7. (d) The differences or modifications mentioned by those who have described the disease were numerous. Dr. STEDMAN remarks that the negroes were much less severely attacked than the white inhabitants; and yet the only three fatal cases which occurred in the island were 9. II. CAUSES. Nearly all who observed this negroes. Dr. DICKSON, of Charleston, states epidemic in the Western hemisphere have conthat excessive determination of blood to the sidered it infectious. Drs. STEDMAN and DICKhead was frequent, and that delirium was pres- SON, who have given the fullest account of it, ent in several instances; but that it went off concur in this opinion. The introduction of the with the fever of the first stage, which did not disease from one island to another, and the propremit, but subsided in a short time-on an av-agation of it from persons and places to otherage, in about thirty-six hours. The skin aters, were so frequently and so incontrovertibly this stage was at first hot and dry; but an proved, that no doubt as to the fact of its inabundant perspiration was thrown out, attend- fectious nature was entertained. But how did ed occasionally by a rash or miliary eruption. it originate? for there was nothing in the medThis eruption appearing in the first stage (notical topography, the season, the weather, or the the characteristic eruption), was very various, climate of St. Thomas, where it first appeared, and not the regular or true one. Children were in the West Indies, to account for the occuroften thus affected by it, and in several adults | rence. Dr. STEDMAN states, in his very dis