in reference to the above diseases, and in which he states his absolute disbelief in the existence of a malarial remittent fever. Thinking' you may perhaps find it of interest to your readers, I send you notes of a case which I have recently had under my care in Calcutta, which tends to show, how the two diseases may undoubtedly occur in the same person at the same time ; and by doing so, display some of the characteristic features of each. On April 18th I was called to see a strong- European boy cut. 10. On 13th and 14th he had been slightly feverish ; on the 15tli he was seemingly well; 16th, strong fever, which subsided after a big dose of castor-oil had beeu given; 17th, well; 18tli. when seen, very irritable, headache (frontal), temperature 104?. pulse rapid. 125, weak ; skin very dry; vomiting of bilious matter. Pain on pressure in hepatic and gastric regions. Antipyrii.i and Calomel and Jalap powder given ; 19th, much
better; temperature normal,quinine given; 20th, again strong fever with vomiting. Antipyrin again given but seemed to exaggerate vomiting, so Antifebrin tried ; no reduction of temperature. On the 21st Dr. Birch kindly saw the patient, and agreed with my diagnosis of remittent fever. He advised
and Morphia, but without effect. On 22nd Tinct. 1. Vin. Ipecac, m 1 every 30 minutes, checked vomiting, and quieted patient, who had passed a very delirious night; 24th, stomach slightly tympanitic, 3 stools, natural colour ; 25th, some slightly suspicious rose-coloured spots on abdomen observed and marked, no motion ; 26th, pain and gurgling on pressure in right iliac fossa. More spots on abdomen, typical typhoid stools. Temperature 104?. This condition lasted from the 27th to May 6th, patient havingseven oreightstools daily, and iced bath being required sometimes three times aday to relieve hyperpyrexia, which at one time reached 107.2?. On May 6th slight congestion of lungs noticed. Patient takes food well but mechanically, only when it is offered, otherwise unconscious, defecation and micturitiou involuntary. On 6th heart's action very feeble, relieved by digitalis and brandy. An exacerbation of fever, usually followed a feeble fluttering pulse; 7th. temperature rapidly fell from 103i?to 100??,and remained so till 10 o'clock at night when a severe attack of cardiac failure ensued. This was combated with sinapism to chest, strong beef tea and brandy internally, and ether hypodermically, but it was a very critical half hour ; 8th, early in the morning, the temperature rose to 106?; and some crepitations were observed in both bases of lungs, also some splenic enlargement, and retraction of abdominal wall on pressure, in that region, as if painful; 9th. undoubted signs of double basic pneumonia. Spongiopiline jacket wrung out in hot water, greatly eased breathing, and by exciting a free perspiration, reduced fever; 12th, fever 102.J0, lungs much better. Without perceptible cause, severe paroxysmal griping came on. in umbilical region, unaccompanied by any signs of perforation ; they lasted three days, and were then subdued by opium and belladonna internally and morphia hypodermically, with external heat to the abdomen by means of a Japauese stomach warmer, round which a layer of damp flannel was wrapped. During this time a?d beef tea per the patient was fed with peptonised anum, only medicine and small quantities of iced water being given by the mouth ; 16th.lungs quite cleared up ; no cough. Can understand and answer when spoken to. Tem-
Quinine Aconit.
m
mifk
perature 102?; 19th, temperture 99?; 20th. temperature normal ; 24th, in morning, temperature suddenly rose to 103?c, skin hot, dry and pungent but soon fell, accompanied by perspiration. June 4th, patient quite well, only weak; 5th. sent to Darjeeling.
better; temperature normal,quinine given; 20th, again strong fever with vomiting. Antipyrin again given but seemed to exaggerate vomiting, so Antifebrin tried ; no reduction of temperature. On the 21st Dr. Birch kindly saw the patient, and agreed with my diagnosis of remittent fever. He advised
and Morphia, but without effect. On 22nd Tinct. 1. Vin. Ipecac, m 1 every 30 minutes, checked vomiting, and quieted patient, who had passed a very delirious night; 24th, stomach slightly tympanitic, 3 stools, natural colour ; 25th, some slightly suspicious rose-coloured spots on abdomen observed and marked, no motion ; 26th, pain and gurgling on pressure in right iliac fossa. More spots on abdomen, typical typhoid stools. Temperature 104?. This condition lasted from the 27th to May 6th, patient havingseven oreightstools daily, and iced bath being required sometimes three times aday to relieve hyperpyrexia, which at one time reached 107.2?. On May 6th slight congestion of lungs noticed. Patient takes food well but mechanically, only when it is offered, otherwise unconscious, defecation and micturitiou involuntary. On 6th heart's action very feeble, relieved by digitalis and brandy. An exacerbation of fever, usually followed a feeble fluttering pulse; 7th. temperature rapidly fell from 103i?to 100??,and remained so till 10 o'clock at night when a severe attack of cardiac failure ensued. This was combated with sinapism to chest, strong beef tea and brandy internally, and ether hypodermically, but it was a very critical half hour ; 8th, early in the morning, the temperature rose to 106?; and some crepitations were observed in both bases of lungs, also some splenic enlargement, and retraction of abdominal wall on pressure, in that region, as if painful; 9th. undoubted signs of double basic pneumonia. Spongiopiline jacket wrung out in hot water, greatly eased breathing, and by exciting a free perspiration, reduced fever; 12th, fever 102.J0, lungs much better. Without perceptible cause, severe paroxysmal griping came on. in umbilical region, unaccompanied by any signs of perforation ; they lasted three days, and were then subdued by opium and belladonna internally and morphia hypodermically, with external heat to the abdomen by means of a Japauese stomach warmer, round which a layer of damp flannel was wrapped. During this time a?d beef tea per the patient was fed with peptonised anum, only medicine and small quantities of iced water being given by the mouth ; 16th.lungs quite cleared up ; no cough. Can understand and answer when spoken to. Tem-
Quinine Aconit.
m
mifk
perature 102?; 19th, temperture 99?; 20th. temperature normal ; 24th, in morning, temperature suddenly rose to 103?c, skin hot, dry and pungent but soon fell, accompanied by perspiration. June 4th, patient quite well, only weak; 5th. sent to Darjeeling.
