dies adapted to cure dropsy originating in disease of the kidneys. I give the outline of a case now under treatment, in which kidney dropsy was at first suspected; but a more full examination and development showed the chest symptoms to be the key to the disease.

Case. Child of Mr. J., six years old. Had scarlatina in the country three weeks ago. Saw him May 16th. At that time, though about the house, he was bloated in the face, lower extremities, and abdomen, which had some fluctuation on percussion. Urine scanty and high-colored. He had Apocynum can., a dose each two hours.

May 18. No better. Bloating increased. Bell. and Apocynum alternately.

May 20. Some sore throat; other symptoms no better. Mercurius solub. and Apocy. alternately each two hours.

21st. Found the patient considerably more dropsical; pulse 130; breathing quick and short, as in pneumonia, though he has little cough. Examination of the chest showed that the left lung was congested and the heart laboring violently, as I thought, to force the blood through the obstructed lungs. The urine was more abundant and lighter-colored than two days before. R Phos. and Tart. emet. in solution, a dose each two hours, alternately.

22d. Better. Slept well; breathing better; the respiratory sound not so harsh and loud through the left lung. The bloating about the face is less, abdomen smaller, legs about the same; pulse 106, and much less excited. Continue the Phos. and Tart. emetic.

23d. Better. The bloating is less, though the abdomen is not so much improved as other parts. Pulse 92, and more natural. Less loudness of the respiratory murmur in the left lung. R. Phos. and Tart. emetic as before.

24th.

Better in all respects. Urine quite abundant. Continue the same remedies, a dose each three hours.

§ III. - 10

25th. Improving in all respects. To continue the same remedies each three hours. On the 27th, he had Sulphur 3 every three hours; and, on the 29th, Bryonia for a little cough. He was discharged convalescent June 1st.

The forms of this disease which arise from affections of the liver with water forming in the abdominal cavity, and then passing up into the chest, or similar results from diseases of the kid: neys, will not be considered in this paper farther than to say that the original trouble must first be cured; and, if it cannot be, then the chest disease will be incurable also. The dropsy of the chest that arises from aneurismal, cancerous, and other tumors pressing upon some of the large vessels of the abdomen or chest, are very much beyond the reach of medicine, and are not considered here.

In conclusion, allow me to say that I give this effort to the profession, all imperfect as it is, confident that some of its most important doctrines are correct and will repay attention and further investigation. The effort which I have made to bring them clearly before my mind, in order to state them clearly to others, has been of much service to me; and I have no doubt that a careful study of the subject by my medical brethren from the few hints here given, will lead to a very good understanding of the subject; and that the fruits of the treatment, so scantily gleaned, may result in the relief of some stricken fellow-creature, is the wish of the writer.

VIII.

THE EPIDEMIC OF YELLOW FEVER AT NEW ORLEANS IN 1867.

BY WM. H. HOLCOMBE, M.D., NEW ORLEANS, LA.

Ir is not probable that many members of the American Institute of Homœopathy will ever have occasion to treat a case of yellow fever; but no physician who loves his profession, and takes pleasure in the study of natural phenomena, can fail to be interested in the history, symptoms, and character of this extra ordinary and formidable disease. In the history of medicine, its successful treatment by homoeopathy will take rank with the triumphs of the same practice in Asiatic cholera. We have competed with the old school, over and over again, in combating these dreaded scourges of the human race; our laurels are found in the increasing faith, respect, and gratitude of the most enlightened public. Our ignominious failure is always loudly predicted at the beginning of these epidemics; but the voices of derision at infinitesimal doses die gradually away into faint eulogies of the powers of Nature in curing homœopathic patients.

It is not my intention to go over the same descriptive and speculative grounds which I attempted in my extended monograph on the great epidemics of 1853 and 1855. With increasing years, our tendency to philosophize diminishes; and our minds look eagerly around, not so much to adjust our practice scientifically to our theories, as to seize the most available and successful means to our ends. I propose to communicate here

some ideas, almost wholly practical in their nature, which were suggested by my large experience in the epidemic of 1867.

There never yet was an epidemic of yellow fever in which many people, and some physicians, did not say, "This is not yellow fever at all." With forty thousand yellow-fever cases around us last year, many physicians - creoles, particularly saw no deaths but those from "pernicious fever"; and it became quite common to hear the disease spoken of ambiguously as "the prevailing epidemic." Why this hesitation and uncertainty? Simply because yellow fever has what may be called the widest and most varied phenomena of symptoms of any disease in the world. Moreover, it is continually changing its type, and, in some measure, even its form. Yet, through all its protean shapes, its fundamental character may be detected, like a musical air, keeping its steady way through the most eccentric varia

tions.

Yellow fever formerly ravaged the cities of New York and Philadelphia as severely as it now does New Orleans and Havana. Since 1820, the disease has not appeared in the Northern cities, except to a very limited extent along the wharves to which it had been brought by shipping directly from the tropics. Previous to 1850, the equatorial line was regarded as an impassable barrier to the yellow fever, that disease having never been observed in the southern hemisphere. Now it is common in all the South American ports north of Buenos Ayres.

Within the memory of living physicians, the yellow fever never attacked the native creole population, never extended beyond the suburbs of cities or towns, never attacked the same person a second time, never occurred in the pure negro race, and rarely seized upon children. Now it attacks children, negroes, creoles, and acclimated persons indiscriminately. A first attack is no certain security against another, and the second attack is sometimes the worse of the two. It visits hundreds of places on the lines of public travel where it was

never known before, and penetrates miles away into the quiet and privacy of rural retreats. To compensate for this vast increase in the area of the disease, it has diminished in virulence to an extraordinary degree. It has been estimated that twice as many cases occurred in New Orleans in 1867 as in 1853, and still there were only one-third as many burials. Physicians claim, and the public assent, that this is the result of more rational treatment, and this is no doubt partially correct; but those who have witnessed the epidemics since 1853 will concede the vast increase of mild cases in latter years.

Yellow Fever is a disease of such varied symptoms that a prompt diagnosis is sometimes extremely difficult. It has been remarked that, if a physician unacquainted with its phases were introduced into a yellow-fever hospital, he might very easily conclude that half a dozen different diseases were presented for his inspection. Hence the great uncertainty which prevails at the beginning of an epidemic, as to whether it be yellow fever or not. Even physicians of the greatest experience hesitate to commit themselves in the affirmative, until they can point to death with black vomit, the only unquestionable test of it, in public opinion.

What is the cause, what is the hidden law, which regulates these phenomena? Do not these curious changes of place, type, and general character of this remarkable disease, and especially its greater diffusion and increasing mildness, warrant the hope that it will become gradually merged into the regular endemic diseases of the country, and disappear from the tropics as a terrible epidemic?

The Fever of 1867 began in June, slowly increased in July, became rapidly epidemic about the fourth week in August, and raged with great fury during September and October. It decidedly diminished from the first of November, but still did not totally disappear until about the middle of December. I met with no case in my practice resembling yellow fever until the