of His human body-becoming rent and riven, as for us "He poured out his soul unto death"; "the travail of His soul" in that awful hour thus standing out as unspeakably bitterer and more dreadful than even the travail of his body."

[Signed]

Edinburgh, May 1, 1862.

J. Y. SIMPSON, M. D.

It will form a

This remarkable work of Stroud has been recently reprinted by the Messrs. Appleton in the best manner. valuable addition to any library.

A TABULAR HISTORY AND ANALYSIS OF ALL THE UNDOUBTED CASES OF TYPHOID AND TYPHUS FEVER Treated at the Boston City Hospital from the date of its Opening, June 1, 1864, to June 1, 1869. By J. BAXTER UPHAM, A. M., M. D., late Visiting Physician to the Hospital. Boston, 1870.

This brochure of 93 pages, 8vo., presents in a condensed and tabular form, the history of all the undoubted cases of typhoid and typhus fever which were treated in the Boston City Hospital for a period of five years. The tables are so arranged as to exhibit in order the following particulars:

1st. The number of the case in the chronological order of admission to the hospital.

2d. The name, sex, nationality, and occupation of the patient, and a reference to the volume and page in the hospital record, where it may be found.

3d. The patient's age.

4th. The date of admission to the hospital.

5th. The period of the disease at which the patient was admitted.

6th. The duration of the disease up to the time of convalescence or death.

7th. The result.

8th. The early and late symptoms.

9th. The treatment.

There are, of course, separate tables for typhoid and typhus

fever, exhibiting the history and analysis of one hundred and

fifty-two (152) cases of the former, and thirty-eight (38) cases of the latter disease.

The utmost care has evidently been taken to insure the accuracy of the details as far as they go, and it is needless to say that such a publication will prove of inestimable value to some future historian of these diseases, who will collate the facts and phenomena here recorded with those which have been collected or may hereafter be collected with equal care and conscientious

ness.

Out of 148 cases of typhoid fever in which the age is stated, considerably more than half-namely, 83 cases, occurred between the ages of 20 and 30, and the average was 22 26-100 years, being a little higher for the males, and a fraction lower for the females. In typhus fever, likewise, the greatest number of cases occurred between the ages of 20 and 30 years, but the average was higher, being 25 66-100 years, as the proportion of cases occurring at a later period of life was larger.

Half the cases of typhoid fever were admitted in the autumn, the other half being distributed over the spring, summer, and winter months. Of typhus fever 15 were admitted in the summer, 10 in the spring, 10 in winter, and only 3 in the autumn.

The average duration of the cases of typhoid fever, "counting from the time of the first occurrence of lassitude, headache, malaise, inaptitude for mental and bodily exertion, or other manifestations of departure from the normal state of health, so far as it could be ascertained from the testimony of the patient or his friends," and extending to the period when the temperature and pulse had sunk to nearly their normal standard, the tongue had cleared, the skin became soft and natural, and the appetite craved a return to solid and nourishing food with a gradual amendment of strength and spirits, was for the males 32 25-100 days, and for the females 36 91-100 days.

The average duration of the cases of typhus fever which recovered was for the males 18 30-100 days, for the females 19 53-100 days.

It appears that chills, headache, anorexia, pain in the

back and limbs, epistaxis, a sense of lassitude, exhaustion, abdominal pains and diarrhoea, were among the most constant of the early symptoms, being noted respectively in 94, 112, 68, 61, 45, 40, 38, 36, and 58 cases; while in the later stages the symptoms and phenomena more frequently observed were rose spots, abdominal tenderness, tympanitis, gurgling in iliac fossæ, cónstipation, diarrhoea, hot skin, delirium, insomnia, cough, brown and dry tongue, etc., these symptoms being noted in 109, 97, 64, 50, 66, 58, 63, 58, 60, 58, and 54 cases respectively.

Dr. Upham, adverting to the comparative frequency of constipation, as noted both among the earlier and later symptoms in these tables, is "inclined to the belief that in very many cases, absence from diarrhoea, or what would in most diseases be termed a normal quietude of the bowels, has here been put to the account of constipation. Such a misapplication of terms might, naturally enough, get upon the record in a fever where the expectation of the opposite symptom is so constantly present in the mind of the physician." He is unable otherwise to explain the frequent mention of a symptom so much opposed to previous observation and experience. We may state in this connection that in our own observation and experience it is not uncommon to have the bowels confined for eight, ten, or more days under the influence of remedies used to this end, when previously a marked tendency to diarrhoea had been exhibited. We have seldom interfered, even with the mildest enema, under such circumstances in a shorter period than a week, and have frequently allowed a much longer duration of this condi

tion.

The most common of the early symptoms of typhus fever were chills, headache, pain in the back and limbs, soreness of the muscles, lassitude, anorexia, vomiting, increased heat of surface and constipation, these being noted in 14, 23, 17, 8, 12, 16, 10, 11, and 12 cases respectively. In the advanced stages the symptoms more frequently noted were hot skin, suffused eyes, dusky hue, foul odor of the body, dark measles-like eruption, brown and dry tongue, sordes, delirium, stupor, exhaus

tion, and constipation, being recorded in 23, 12, 15, 9, 23, 21, 10, 19, 11, and 19 cases respectively.

Of the 152 cases of typhoid fever recorded in these tables, 131 recovered, and 21 died, the mortality being in the ratio of 1 to 7 23-100 cases. Four of the patients were insensible, and in a well nigh hopeless condition when brought into the hospital. Excluding these the mortality was 1 to 8 70-100.

This is a fair average result, but we are reminded in this connection of the remarkable statements in Dr. Jackson's "Letters to a Young Physician" touching the effects of the early use of emetics on the death rate in typhoid fever. He states that 'among those admitted to the hospital in the first two weeks of the disease, one hundred and fifty took emetics before or after admission; of these 13 died, being one in 11 53-100. In the same period 80 were admitted who did not take emetics; of these 10 died, being one in 8. The difference is very striking. But of the 150 who took emetics, some took them earlier and some later in the disease. It has been thought that the earlier this and other active and depletory remedies are administered, the greater the benefit. See how far this is confirmed by the same report. Fifty-nine entered the first week of the disease, and took emetics in that week; 4 of these died, being 1 in 14 75-100. Thirty-one entered the same week, and did not take emetics; of these 3 died, being 1 in 10 33-100. Ninety-one entered the second week, and took emetics either before or after admission; of these 9 died, being 1 in 10 11-100. Forty-eight entered the same week, and did not take emetics; of these 7 died, being 1 in 6 85-100." But in making this statement of the valuable author of the "Letters to a Young Physician," we have anticipated a point which refers rather to the question of the proper treatment of this disease than to the average mortality.

Of the 38 cases of typhus fever recorded in these tables ten (10) died, showing the very large ratio of 1 death in 3 80-100 cases. One of three fatal cases, however, was moribund when brought, and died six hours afterwards, and three were deliri

ous and unconscious at the time of admission, from which condition they did not rally. Another was a hospital nurse, fortysix years old, excited and overworked, who contracted the disease while in attendance upon patients ill with the fever.

The treatment of typhoid fever was mainly expectant. When an aperient was supposed to be required, castor oil alone, or in emulsion with gum acacia was commonly employed, generally in a very small dose. We find it difficult to believe that such a remedy is ever necessary or safe at any period later than the earlier days of the disease. Restlessness and insomnia were treated with ten grains of Dover's powders, or an eighth of a grain of sulphate of morphia. We have found larger doses necessary. In some cases opiates are not borne at all, and when that is the case, we have usually found that alcoholic stimulants have quieted the patient. In the Boston City Hospital stimulants do not appear to have been employed until called for by "debility consequent upon the latter stages of the disease, or at whatever period of the fever depression and exhaustion of the vital power was manifest." We are fully convinced that beef tea and alcoholic stimulants should be given in the early stages of this disease, if we desire to realize their best effects. them, indeed, be used with proper care and discrimination as to quantity and frequency of repetition, but when so used they cannot, in our judgment, be used too early. They may be resorted to much too late to do any good, if we wait for the "latter stages of the disease, or for signs of "depression and exhaustion of vital power."

Let

Other remedies used in the hospital were, bromide of potassium to allay nervous irritability and induce sleep, tepid or cool sponging, a fever mixture consisting of liq. ammoniæ acetatis 3 ij., mist. camphora, aquæ distill, aa 3 ss., if the fever was excessive, camphor water, Hoffman's anodyne, oil of turpentine, according to Dr. G. B. Wood's plan, etc. Cold water, milk and water, flax-seed tea (weak) were freely allowed as drinks. None but mild and unirritating articles of diet were allowed until convalescence was fully established. During convalescence qui