488 surgeons' reports — California — northern district. 



But with the commeucemcnt of summer intermittents become more abundant, and as the season 

 wears on to autumn, remittent takes the place of the milder form ; from this period, and running 

 even into winter, the typhoid grade is common. 



Every year these diseases follow about the same course, although the regularity depends very 

 much upon the amount of water that falls during the winter-season. 



When, for a number of years in succession, the ground has been saturated, vegetation is very 

 abundant, and every succeeding year vast accumulations are found on the bottoms, in the sloughs 

 and tulares bordering upon the rivers, which decompose rapidly under a temperature of from sixty 

 to ninety degrees, causing an abundant emanation of miasma. Continual exposure to the intense 

 rays of the sim is another powerful agent in exciting, and, I have been inclined to believe, also 

 in predisposing, to disease. 



The northern monsoon prevailing on this coast, from April till October, is a hot dry wind which 

 sweeps through the valleys and over the parched plains, gathering up in its course, and bearing 

 with it, all the noxious gases emanating from the country over which it passes. The current of air 

 thus put in motion loses much of its vit^l properties by exposure to the accumulated heat in its 

 transit over two or three hundred miles of an arid country, and is thus another prolific source of 

 disease. 



In the intermittent variety of malarious fever the paroxysms are mostly regular, but the stages 

 in the beginning are not strongly marked, the one imperceiitibly gliding into the other. At first 

 the temperature is so slightly reduced in the cold stage that attention may not be drawn to its 

 existence for a number of days. The patient complains of general debility, lassitude, uneasiness and 

 restlessness, particularly at night, loss of appetite, with the recurrence of fever, generally every other 

 day. The pulse is considerably accelerated during the exacerbation of fever, but in the interval is at 

 the normal standard. The tongue is but little coated at first, but as the disease progresses, assumes 

 a lighter or brownish covering. After a few days the cold stage becomes more perceptible, some- 

 times, however, amounting to little more than a general coldness over the body and limbs ; at other 

 times the body will convey to the touch the sensation of stinging heat, while the extremities remain 

 cold ; and then, again, rigors will be manifest, and sometimes well-marked chills. The re-action of 

 fever is in proportion to the severity of the chill, or cold stage, and when both the former stages are 

 distinct, the sweating stage is correspondingly profuse. 



When the cold and hot stages are mixed, that is, when fever commences almost simultaneously 

 with the cold stage, then the fever remits from day to day, and never entirely leaves the patient. 

 When this is the case the skin is seldom moist : sometimes, however, for a few moments perspiration 

 may be observed, while immediately afterward the skin will be hot and dry ; or it may be that in 

 this form the symptoms assume a choleraic tendency, anfl the perspiration for most of the time will 

 be profuse, with great oppression in the chest, and almost constant vomiting and purging, some- 

 times of bilious matter, but more frequently of a colorless, serous fluid, unmixed with bile or 

 flocculi. 



Neuralgic pains of the face, head, chest, and limbs are almost constant concomitants of the 

 foregoing symptoms, and still more commonly a powerful determination to the glandular system is 

 observed, which never fails to produce serious disturbance. At other times the fever assumes an 

 enteric form. The tongue is covered at first with a light-brown coat, which is soon partially cleared 

 away, when the whole surface becomes dry and parched. The pulse is frequent, ranging from 90 

 to 130 in a minute, and a peculiar tremulousness also pervades the whole muscular system. The 

 patient is occasionally flighty, particularly after waking from sleep. Sometimes the delirium is 

 considerable; he talks incoherently or forgets to complete his sentence. The bowels are ttsually 

 torpid, but occasionally a dysentery sets in, with distressing tenesmus. The abdomen soon be- 

 comes tympanitic and tender to the touch, affording a crackling sensation to the fingers on pressure. 

 In fatal cases the mucous membrane, and particularly the mucous follicles of the intestines, are 

 found seriously diseased, in so much that the system fails to receive snfiBcient sustenance to main- 

 tain animal life, or death may follow from local congestion induced by nervous depression. 



Putrid sore throat, also denominated dii)htheria, isciomtnoii. Perhaps, as suggested byPichard 

 (jomiiiae, of London, the name oi hcqus iiialir/iiH.s ((ii(/iiWfiHs would more fully describe the disease. 



