242 Epidemics. 



end may be deferred for three or six months longer ; some 

 cases are even still more prolonged. 



A patient comes, say, a young man of twenty-five years of 

 age. He is not himself fancies he is thinner; keeps at 

 his daily occupation as usual, but gets very tired by night, 

 is fresh again after a night's rest, and goes through 

 morning duty pretty well, but flags much towards evening. 

 The appetite is fair, but the relish for food is less than 

 usual ; he smokes, but thinks it scarcely suits him. Here 

 his troubles end, save, perhaps, he has some indigestion, and, 

 may be, some palpitation, with slight dilatation of the right 

 ventricle ; and if very great nicety be used, though the right 

 auricle is naturally possessed of the greatest share of irri- 

 tability pertaining to the several cavities or sections of the 

 heart, yet it will be found, after careful examination, that it 

 is irritable in excess over its natural standard. 



The upper part of both lungs antero-posteriorly are care- 

 fully examined, and the pseudo-complaining patient passes 

 muster, the respiration being perfectly natural, both in 

 regard to the character of the respiration and time ; the 

 pulse is 65 to 75, rarely below the first or above the latter, 

 unless nervous under examination. 



Quinine, iron, alkalines, and vegetable bitters, or some 

 agent to act upon the liver, with instructions to avoid fatigue 

 and cold, amount to the whole that is done. In London 

 patients go and see some new face about once a month, 

 if they fancy they are no better. So, after being seen 

 once or twice, fresh medical advice is sought; the same 

 category is gone through, saving that the patient is most 

 particular to mention that every morning dark phlegm is ex- 

 pectorated. After it has been dislodged the cough ceases, 

 and scarcely ever returns during the day. 



Occasionally an idea is entertained that there is a deficit 

 in the quantity of urine, which is really the case in rare 



