380 



merely convalescent from so prostrating a form of fever, and who of 

 necessity hare returned to their "crowded and ill-ventilated homes 

 and poor fare," would tolerate, much more require, general deple- 

 tion! Even Mr. Mackenzie himself acknowledges "that the wan 

 appearance of many of the patients, the smallness of their pulse, 

 and the state of general debility in which they are, might tend to 

 deter from the use of the lancet — that often it is difficult, from syn- 

 cope coming on, to obtain more than a few ounces from the arm, 

 and that the blood drawn is only in a few instances huffy." There 

 seems a great inconsistency between the opinions just quoted, and 

 those given in favour of the necessity for the use of the lancet. The 

 urgency for depletion must indeed be great, to justify its use in those 

 of "wan appearance, with a small pulse, and in whom syncope fol- 

 lows the abstraction of a few ounces of blood!" As is remarked by 

 Dr. Swett, the treatment of the fever as it prevailed in New York 

 " has invariably been tonic and supporting — that even in those cases 

 in which signs of active inflammation supervened, local depletion by 

 means of cupping was only resorted to." In any objections to the 

 use of the lancet in this disease, I will not trust to mere theory 

 alone, but confidently appeal to facts to sustain me. A careful 

 comparison of the results of the cases treated by Mr. Mackenzie, by 

 Mr. Wallace, and those treated at the New York Infirmary, will 

 prove most conclusively, that the use of the lancet is not necessary 

 for the cure of this disease. 



Mercury. — I most cordially agree with Messrs. Hewson, Mackenzie 

 and Jacob, in the favourable opinion they entertain of the beneficial 

 effects of mercury. Indeed, when we consider the extent to which 

 the retina, choroid and iris, particularly the latter, are involved, and 

 the serious changes they undergo in the progress of the disease, we 

 shouhl not hesitate for a moment to have recourse to this invaluable 

 agent. Pills containing two grains of calomel and a quarter of a 

 grain of opium were given thrice daily; their use was continued till 

 the gums became slightly affected, when either a single pill at night 

 or five grains of Plummer's pill were substituted, and a slight mer- 

 curial influence was thus kept up for some time. For the relief of 

 the supra and circumorbital pain, as well as for the purpose of dilat- 

 ing the pupil, a portion of the following ointment applied about the 

 brow and temple was found of great benefit. R. — Ungt. hyd. fort. 

 §j; pulv. g. opii 3j; ext. stramonii 3ij. 



Tonics. — We are indebted to Mr. Wallace for first calling atten- 

 tion to tho value of this class of remedies in the treatment of this 



