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10 p.m.-Suddenly attacked with a second fit; face drawn to the left side, right arm and side affected with spasms, left apparently paralytic, frothing at the mouth and stertor, insensible. This attack lasted about ten minutes, the pulse bounding with extraordinary excitement-consciousness had already returned before v. s. ad 3xx was performed. Has had no motion since yesterday forenoon. piat statim ol. croton tiglii mj, ex olei ricini 3fs. This was vomited immediately. A dose of scammony and jalap was then given, which was retained an hour and then vomited. Expecting another attack at twelve, I took care to be present a few minutes before the time, when, exactly at the hour, he was again attacked, more severely than before. Powerful convulsions of one side; for a short time, quite purple in the face and chest. Two or three severe opisthotonic spasms, and horrid grinding of the clenched teeth, as in tetanus. Total insensibility-pulse about 90, very powerfully excited, so much, that although convinced that this disease was purely nervous, and little likely to be benefited by bloodletting, and that when this violent excitement passed, it would be succeeded by a condition of proportionate feebleness and prostration, yet I found it absolutely necessary to bleed again, in order to protect the brain. This time sensibility returned more slowly, with expressions of intense suffering from pain in the forehead. To have an injection of magnesiæ sulph. 3j; ext. colocynth co; pulv. jalap. rad. āā ‡j; in warm water, immediately.

2 a.m.-Has vomited three times frothy mucus. Injection retained-repetatur enema; calomel gr. v. statim.

28th., 10 morning.-The second injection brought away little but the first one. Fotor of breath, either from the calomel or from the tongue having been severely lacerated in the last attack of convulsions. Still much excitement of the pulse, although less in power and volume. Headache excruciating, till eight a. m.; when, as usual, it abated, though still severe. Some pain in the region of the heart, the excited action of which is singular. Bowels not free. Borax lotion for the mouth. Enema of jalap and colocynth, aa j; and to take every two hours one of the following pills,—R ferri carb. 3fs; assafœtidæ j; fiant pilulæ x. A blister to be applied to the region of the heart.

4 p.m.-The enema brought away a little dark fœtid matter. There is much drowsiness and disinclination to move; but he is perfectly sensible— headache gone, and no numbness, but weakness of the limbs; pulse gentle, soft, and weak-wholly free from excitement-some pain in epigastrium, slight hiccough, but no return of vomiting since commencing the pills. The enema to be repeated, and to take a glass of wine with arrowroot.

12 p.m.-The enema brought away some dark fluid, smelling of assafoetida: no attack to-night— omit medicines.

After this he took, for a couple of days, carb. ferri ǝj, in syrup of ginger, twice a-day, which acted

gently on the bowels ;* and, except having for a few days a good deal of feebleness, he has since been perfectly well.

Baba Beg, æt. twenty-four, of florid complexion. On the night of January 27, on returning from Mr. R-'s, I found this man recovering his sensibility, after having had two successive fits, which he says were each time preceded by great palpitation and painful oppression of the heart; the pulse is now 85, excited and bounding, but without much power. He has been disturbed for some nights past about the same hour, by sleeping of the right arm; and two nights ago, had a slight fit. His fellowservants tell me, that during the fits his hands were convulsed and face distorted. Ordered compound

jalap powder and calomel.

28th.-Purged five or six times; to take ten grains of carbonate of iron, and repeat it in the afternoon. After this he had no return of symptoms.

Rassool, æt. thirty, my head groom, a spare man, 24th of January, complained of much pain and tenderness of the ears and parotids. I had several patients at this time who complained of the same thing. Ordered Epsom salts 3j immediately-five leeches behind each ear.

25th.-Medicine operated frequently; he feels

* This is a curious fact, which I have observed throughout the whole of the diseases of this year-that while, as frequently happened, none of the usual purgatives produced their effect, a small dose combined with iron acted immediately, as scammony gr. v. ferri carb. gr. x., or ferri sulph. gr. j. aloes gr. ij.

better, but there is still much tenderness and pain— has been disturbed for the last two mornings, by the arm and leg of one side going to sleep a little before daybreak-countenance flushed, pulse 90, v. s. ad

zvij.

26th.-Pain easier, hands still sleep in the morning, compound jalap powder 3j immediately, and ten grains of Dover's powder after the third motion.

27th.—Has been freely purged. Occasionally great numbness of the limbs, and headache; in the evening was said to have fainted.

28th. Still purged, looking worn, pulse much excited, numbness of both legs and one arm; severe headache—cap. ferri carb. gr. x; et repetatur post horam.

Evening. Has been purged several times since morning, and has not taken the powders; headache very bad. Ordered pills of assafoetida, sulphate of iron, and opium, every two hours.

Midnight.-Pain in head excruciating; lower limbs insensible, in a state resembling paraplegia, and one arm quite numb-shows great disinclination to move, has refused all medicine, wishes to be left to die-said to have been twice insensible-purging still continues-forced him to take two of his pills.

29th.-Last night, having found himself better after the pills, continued to take them till morning, and is now free from headache and numbness, and all excitement of the pulse is gone. To omit medicines, and to take carbonate of iron, one scruple, in the afternoon; had no return of the symptoms.

I have stated these first cases that occurred to me in detail, to show how completely I was at a loss as to the treatment which ought to be pursued. At length, three people, under my own eye, were attacked, almost at the same hour, with fits, which I could not help recognising as similar to those of which I had seen Syad Khan die. On that day, numbers had also applied to me with nervous pains, headaches, pain in the region of the heart, and nightly sleeping of the hands and feet. Venesection seemed to do harm, as well as all reduction of the system: in the two first cases, loss of blood was followed by fatal attacks. In the third and fifth, when blood had been drawn, the disease was severe. In Mr. R.'s case, quinine, as I administered it, was evidently not to to be depended upon. Purgatives seemed to do no good; and in Rassool's case to do harm. What was then to be done?

I reflected that all the different cases had one thing in common-that during the fit, the arterial system was intensely excited without either feverish skin or hardness of pulse: that this excitement must be purely nervous, for the pulse was at another time as soft and quiet as during the access it was excited and bounding. I therefore determined to trust to assafoetida as an anti-spasmodic during the fits, and to hope something from the power which iron possesses, of counteracting irregular arterial action (especially in the spleen and uterus). I little expected to find these remedies so valuable as they afterwards proved.