manifest tendency to recur, but even to resist the bark given in substance.

In those painful affections of the nerves of face, which almost constantly assume the form of a regular intermittent-it has been thought requisite to administer the bark before the employment of antispasmodics. Does this necessity, in most cases indispensable, arise from an extreme sensibility of the whole system, or of the alimentary canal alone? Several cases of neuralgic affections have occurred without this disposition, which have been cured solely by the use of cinchonine. The two cases which have just been given, present this peculiarity, that in the first, the stomach still suffering from the consequences of inflammation could not have born a dose of the bark, in substance sufficient to have stopped the approach of paroxysms so violent; and in the second, the trials made with bark in powder were fruitless, as the stomach rejected them. In the last case where the symptoms of malignant intermittent, were accompanied with other alarming complaints-how large a quantity of the powder would it not have required, to have equalled the effect produced by the sulphate of quinine?

From these and other cases, the following conclusions are deduced; that the sulphates of quinine and of cinchonine contain all the virtues of the bark, in stopping the course of intermittents; that the sulphates being soluble, do not derange the digestive powers in the same manner as the bark itself containing the woody part, the indigestibility of which, it is probable, often prevents the administration of the cinchona in doses sufficient to obtain the requisite effects;-that the loading with bark a stomach unable to digest it, may be productive of serious affections; that the sulphates of quinine and cinchonine, can easily be made adequate to any determinate dose of the cinchona, and that in urgent cases this dose can be carried as far as is necessary, without any great inconvenience;-that the quantity of quinine and of conchonine contained in any one kind of cinchona, is the test of the comparative virtue of the different species; that the absence of these alkalies in vegetables, which have been proposed as substitutes for cinchona, shows the little confidence which ought to be placed in them; while those in which these alkalies are found may supplant the cinchona.

The experiments recently made by MM. Robiquet and Petroz, jun. on the bark of the carapa, which has been known in some countries of America to cure agues, which had defied the cinchona-come in aid of this last assertion; for MM. Robiquet and Petroz have found in that bark an alkali analagous to quinine: whence it results that the alarm enter

tained as to a scarcity of cinchona, on account of the destruction of the trees, ought to yield to the hope of seeing the number of febrifuge remedies increased, without being obliged to wait for the discovery of their virtues, on a tedious and doubtful experience.

The Memoir of M. Chomel confirms all the results which he had formerly announced. It establishes the innocence of the sulphates of quinine and of cinchonine, in doses adequate to the subversion of fever;-it points out that the dose must be increased when we use the cinchonine ;-it shews that the disadvantages attending the bark administered in substance, in doses sufficient to check fever, have not yet been observed in the use of the sulphates a result which may be owing to the very small bulk of a powerful dose, and, perhaps, also to the liberation of the quinine and conchonine from other elemental substances, with which they are conjoined in the bark.

Notwithstanding, however, the evident innocence of these sulphates, in the cases detailed in the Memoirs of MM. Petroz and Chomel, as well as in those of many other physicians, it appears somewhat improbable that substances of so powerful a nature as these two alkalies, and of so intense a bitter, should in no case produce any marked inconvenience. It remains therefore to ascertain how far they are innocent, both as it regards the dose and the state of the patient, and what inconveniences may arise from their abuse, for we have but an imperfect knowledge of a remedy, when we are acquainted only with its advantages. We know, continues M. HALLE, not of ourselves, but from physicians worthy of credit, that the sulphate of quinine given to a child with success in an intermittent, has been followed by spasmodic affections, which have created the presumption that it may be productive of mischief. This observation is not sufficiently established to be stated with confidence, it is made solely with a view of inviting the profession to turn their attention to this important point.

The fears of M. Hallé on this subject are confirmed by MM. Larrey, Duponchel, Emery, and Heller, who have all communicated to the Société Médicale d'Emulation, facts which tend to justify so reasonable an apprehension of danger.

OMODEI

ON THE EPIDEMIC OF LOMBARDY.*

WE can say little new upon epidemics and contagion, The subject has been absolutely written down, and is become quite trite and commonplace. But it is still an important one, and will always interest. From the celebrated epidemic of Athens, so eloquently recorded by Thucydides, up to the last published brochure sur la fiévre jaune, an anxiety, both general and individual, has been as often renewed, as epidemics have renewed their baleful ravages. The epidemic of Lombardy, which raged in 1817-18, adds another to our former catalogue, and we think its history of importance, chiefly as it affords a comparison with that of other epidemics. From the perusal of this long paper of M. Omodei, which, by the way, is only half of what he promises: it is not difficult to see, that its spirit is very similar to, "Cenno sull' Oftalmia di Egitto e sulla sua propagazione in Italia," the success of which, all over Italy and France, and the high praise it received from most of the medical journals augurs well for the present performance.

In fact, if in the first, the facts were well separated from hypothesis, here, the author has made the most happy efforts for reducing to general facts, every thing previously known or pretended to be so. For the present, we shall content ourselves with a condensed outline of his description of the disease, its varieties, complications, and termination.

The disease showed in its course, the usual periods of commencement, exacerbation, crisis, and decline, common to acute febrile diseases, and particularly to the contagious ones. As soon as the patient was attacked, he felt either immediately, or some days after, that weakness and uneasiness-those rigors in the back and extremities, with which fever is commonly accompanied. These symptoms were followed by an extraordinary heaviness of the head; a sensation of painful stretching in the back, loins, and extremities; of compressing pain on the stomach, in general, accompanied by giddiness, nausea, and sometimes,

Prospetto, nosografico-statistico-comparativo della febbre petecchiale che ha regnata epidemicamente nella Lombardia, nel 1817-18, ossia, Commentaria sul governo politico-medico di questo morbo &c. con, 22 tavole. Dell' Editore. Annali universali di Medicina, compilati dal Sign. Dr. Annib. Omodei, vol. xvii, 1821, Milano.

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even vomiting of food, or bilious greenish and yellow matter,with dryness of the throat and nostrils, oppression and weight on the thorax, with the pulse frequent and strong, flushed face, heat equal all the over body, thirst, anxiety, &c. Every thing, indeed seemed to announce a simple inflammatory fever; except that the eyes, from the first attack, were rather glazed, and the conjunctiva and eye-lids of a reddish cast; which, with the vascular sub-cutaneous swelling, characterized in such a manner the physiognomy of the patient, that an exercised practitioner might have foretold, from the face alone, the nature of the morbid process.

Sometimes, this particular physiognomy could be observed even before the formation of the fever, and it never abandoned the patient, notwithstanding, many strange variations during the progress of the disease. Meanwhile, the redness of the eyes was always increasing, and with it heaviness of the head, numbness of the limbs, inertia, restlessness, anxiety, and want of sleep. Fear and pusillanimity, at the first attack of the disease, appeared only in few; and in general, the mind was no more troubled than in common cases of fever. The pulse was always full and frequent, sometimes depressed, never weak; the throat was swelled, the tongue loaded, the thirst troublesome, and the urine scanty and reddish. On the fourth day, after an evident evening exacerbation, preceded by remission in the morning, eruptions usually broke out on the skin, particularly on the breast, neck, and back, and all the parts most defended from the air. Sometimes, plain, reddish, circumscribed spots; sometimes, little papule, similar to the sparsest miliary ones, occasionally so confluent, and raised above the surface, as to imitate a kind of nettle rash. Sometimes the eruption was so sparse, deep, and copious, as to give to the skin a marbled appearance; and sometimes, it was necessary to look at it obliquely and against the light to discover it. More than once there was no visible eruption. In general, all these variations, had not the least influence on the degree of the other symptoms, and the slight remission on the fourth day, was common to every case, whatever was the period or the quality of the eruptions, or even without any eruptions at all.

The disease advanced thus till the eighth day, when a new febrile exacerbation, preceded by some hours of illusory decline, increased the former morbid phenomena, except the catarrhal symptoms, which frequently became milder, but sometimes remained the same, particularly when the mind was not much affected. The inertia was then converted into a real incapacity of any voluntary movement, and the patient lay motionless. Few

retained the faculty of changing place at this period, and this circumstance was always favourable. The heaviness of the head and the stupor of the mind, were now degenerating into a real coma with delirium. The skin dry and burning; the tongue white, red, and black, and incapable of motion; the pulse slower and depressed, the urine clearer and paler, the stools more fluid and frequent, deglutition more difficult and nearly stopped. Besides tremor, subsultus tendinum, hickeup, convulsions, and the abdomen, which could bear compression the first week, became all at once swelled, and painful to the touch, so that the patient was half awaked by it, and shewed frequently on the face the muscular contraction called risus sar donicus. The touch, taste, and smell, were in general entirely destroyed; the sight, and hearing, were very much weakened. Of all the faculties, the memory was the most impaired.

A new spontaneous exacerbation of heat, fever, and nervous perturbation, appeared about the eleventh day; diminished the next, and this being reproduced on the thirteenth or fourteenth, brought the patient (at that period insensible) to the tomb; or by a sudden change restored him to health, as one roused from a deep lethargy. In most cases, this sudden crisis was preceded by a copious and equal perspiration, and softness of the mucous membrane, which covers the nostrils, the throat, the trachea, the lungs, &c. and thus it happened, that the thick and blackish mucosities, which on the first cavities were even visible, were easily detached, and spit up. At other times, the crisis was effected by copious urine, full of sediment, or by slimy foetid stools; at other times by hæmorrhage, particularly from the nose. But most frequently, the disease decreased without any sensible change in the secretions or excretions of the skin, kidneys, bowels, &c. at least, to such a degree, and of such a quality, that any proportion could be established between them, and so rapid a diminution of all the morbid appearances. A very few cases finished by a gangrenous decubitus over the os sacrum or the extremities. Swelled parotids were never a good omen.

The disease, however, did not always advance in this regular way. Anomalies and complications, amongst which inflammation of the brain, lungs, bowels, and liver, were the most common, occurred more than once, for which, neither the condition of the patient, the influence of the air, nor other circumstances could sufficiently account. But, as it happens in the small-pox, which in the same family, is confluent in one, and mild in another, so was it often the case in this-(how shall we call it?)-petechial fever. In the work before us, it is called petechial fever, after the author balanced for a moment, between