tuce, and for the nervous irritation of the later stage, attended with a low muttering delirium, camphor with opium, or Dover's powder, have been found beneficial; as was musk in one very obstinate case, and laxatives in another. Refrigerants internally and sponging with tepid or cold water, were not only grateful but salutary in mitigating the thirst and heat of fever- taking care during its entire course to keep the bowels in a soluble state by laxatives or laxative enemas, and the diet and regimen carefully regulated, and the patient faithfully watched these last means being, perhaps, the most important items after all in the successful management of this disease. But the great trial of judgment and skill (notwithstanding what has been said of the sounds and impulse of the heart, and the symptoms of collapse so clearly laid down in the books) consisted in the administration of tonics and stimulants at the proper time. So suddenly did symptoms of collapse occasionally supervene, that the use of stimulants and tonics, which an half hour previously one would have feared to employ, was now most imperatively demanded. Indeed, it was not safe to omit having all things ready, and strict and full directions left with the nurse or friends when they should be resorted to, in case the physician was not at hand, or readily to be consulted. And yet, as Dr. Nathan Smith long since said, "Typhus fever" (our typhoid), "like the other contagious diseases, has a natural termination, and if it does not end fatally, exhausts itself and disappears"—especially, it might be added, if mild in character, and treated on a judicious expectant plan, appropriately meeting any local inflammations which may arise. By far the larger number of cases witnessed by the writer were of this mild form, where the patients expressed themselves as "comfortably sick," passing safely through the complaint with confinement to bed in clean, airy, and well ventilated, but darkened apartments, sustained by a bland, farinaceous diet, and encour

aged by the hope of a safe deliverance, not a dollar's worth. of medicine being needed in the treatment of many cases from beginning to end; unless, as has already been intimated, some error in diet or regimen was committed by the patient or his friends, when relapse was sure to follow, to the great discomfort of the physician, who may be thus doomed to see all his watchful care unrequited, and his anxiety for the welfare of his patient renewed, when he had just begun to breathe freely and easy, expecting soon to see him abroad; but the patient is now to learn from his own sad experience that fever can, by one imprudent step, be rekindled, himself to become sicker it may be than before, should he be so fortunate as eventually to recover.

In all cases where there was (about the end of the third week) an amendment evinced by the cessation of the febrile paroxysm, diminution of the frequency of the pulse, and a cleaning, moist tongue, with returning appetite, the infusion of mild bitters, as chamomile, or serpentaria, with the addition of tincture of quinine, followed by cascarilla and bark, aided in restoring the lost tone, and promoting the patient's strength, assisted by a diet gradually improved by uncooked or boiled milk, or cream, pounded biscuit, rye-pudding, or soft-boiled rice, soft-boiled eggs, or oysters, and the lighter meats, in the order here enumerated, and in moderate quantities, until convalescence was firmly established, when the patient was fully cautioned as to exposure to the weather, and left to make good his recovery.

The preceding remarks are of so general a character, and the speculations offered so devoid of any novelty, that they may be regarded as scarcely worth the time which has been consumed in their recital. They have been framed, as well as penned, amid many cares, and are offered chiefly to show the willingness of the writer to comply with the invitation to contribute his mite, however small, to the gene

ral stock of human knowledge; and because an opportunity was thus offered to draw an outline of fever as exhibited in a part of the Commonwealth not heard from on this topic for the last thirty years. They are submitted with diffidence, heightened by the remembrance of the finished essays and elaborate reports which have heretofore been presented by the masters of our art. But the private who has stood at his post, no less than the General who planned the attack, cannot but occasionally reflect upon the scenes through which he may have passed, and may be permitted to rehearse the manner in which he has met the foe; and if he has faithfully discharged his duty, may confidently rely upon the candor of his comrades to mete out to him the merit he deserves.

ARTICLE II.

TOPOGRAPHICAL DISTRIBUTION

AND

LOCAL ORIGIN

OF

CONSUMPTION IN MASSACHUSETTS.

BY HENRY I. BOWDITCH, M.D.

OF BOSTON.

READ AT THE ANNUAL MEETING, MAY 28, 1862.*

MR. PRESIDENT AND GENTLEMEN :

AT this dark, but, as I deem it, most glorious epoch in the history of the Republic, and while hosts of armed patriots from all the loyal States are gradually and firmly encircling, as with a wall of fire, the traitors to our country's peace, we-as one small corps of that grand army, whose

have again met, on this our annual festival, for fraternal interchange of thought on topics connected

*At an Adjourned Meeting of the Mass. Medical Society, held Oct. 3, 1860, it was Resolved, "That the Massachusetts Medical Society hereby declares that it does not consider itself as having endorsed or censured the opinions in former published Annual Addresses, nor will it hold itself responsible for any opinions or sentiments advanced in any future similar addresses."

Resolved, "That the Committee on Publication be directed to print a statement to that effect at the commencement of each Annual Address which may hereafter be published."

with the science or art of our noble, but peaceful profession. The heart of the Nation is in mourning for her soldiers slain in the beauty of their young lives and of their heroic deeds, on the battle-fields of our common country. We, too, lament the loss of many of our well-known and respected fellow soldiers in the battle of life, who, since our last gathering, have left our ranks only to join the mightier hosts of the dead. A few moments spent in commemoration of their virtues will tend to hallow this hour, which, year after year, we devote to professional discourse.

Not less than twenty-seven of our number have died during the past year; a larger number than has ever been known before within the same period of time. Most of them filled, to the entire satisfaction of the various communities in which they lived, the sacred office of Family Physician. They need no higher or sweeter eulogium; for that office, worthily filled, carries within itself as rare a combination of virtues possessed and of duties done as usually falls to the lot of man.

I shall not, I hope, be deemed unjust to the memory of others, or as using the language of unmeaning panegyric, if I allude more distinctly and personally to two of them; one of whom was but recently our President, while the place of the other as Secretary has become vacant only within the last few weeks. As officers of this Association, therefore, if for no other reason, we owe to their memories, at the present hour, our tribute of respect.