The administration of calomel pushed to ptyalism has been vaunted in the daily papers as an excellent method of treatment of this fever, and an exemption from urinary suppression in those treated in this mode has been proclaimed. Since this symptom is the essentially fatal one in the disease, it would be well if facts enabled one to announce any remedy as preventative. My own experience, however, obliges me to condemn any specific use of mercury. It has seemed to me, however, of great advantage in many cases as a purgative, and something more, also, probably from its special soliciting effect upon the entire glandular system of the digestive apparatus; but when it has produced any degree of ptyalism, it has caused me regret - in one case it certainly increased the jaundice.

I have to rectify my statement with reference to the epidemic of last year (1870). The disease was not confined to an hotel, but to the "block" of houses of which the hotel was one, and to persons from adjacent parts who had communicated with the infected centre. The outbreak existed from the end of March to the end of June. The number of deaths has been stated at 100; in the lazaretto thirty-two persons were received during the period.

I have good evidence of the importation of the disease this year (1871) from patients of mine residing in the block in the San Telmo parish where the disease broke out. A sailor came ashore with the fever to this port, and then it spread gradually about the same neighbourhood. Persons residing in the "block" affected last year assure me that this locale has scarcely suffered this year from the outbreak, although adjacent "blocks" have been sufficiently attacked; yet posteriorly to the appearance of the disease in the distant quarter of San Telmo - a part of a mile distant at least from the infection-spot last year. My friend Don Ignacio Pirovano - a very distinguished native Surgeon at the Hospital de Hombres - gives me his testimony in favour of the value of antiperiodic doses of quinine for calming the neuralgic pains, which are such distressing symptoms in the disease.

Thinking on the natural history of the fever we have combated, and the asserted "single paroxysm" character of the disease, I desire to offer the following observations. Following descriptions we read of the three stages, thus:- 1st, febrile; 2nd, apyrexic; 3rd, adynamic; and I would express my ideas on the disease as being - 1st stage, attack; 2nd stage, remission; 3rd stage, abortive repetition. Or, better, thus:- 1st stage, attack, then interval, remission; then 2nd stage, attack aborting from adynamic impotency to carry out the phenomena. The liver is described as being in a condition of acute fatty degeneration; it seemed rather to me to be: 1st, sanguinous; and 2ndly, biliary congestion. Its colour is not the buffy of a fatty organ, but a true rhubarb yellow - biliary colour.

In this month's "Review of the Buenos Ayres Medical Association" is the letter of the Medical Officer of the port of Monte Video, stating his opinion of the nature of the disease which had then recently appeared in Buenos Ayres, Appended to it is the following document:-

"I the undersigned, Doctor in Medicine and Surgery, at the request of Dr, Garriso, Medical Officer of Health at the Port of Monte Video, give the following information:-

"Through a person in whom I have complete confidence, who has come from Paraguay, I have learnt that, when there existed in that city that which was called yellow fever, Dr. Joaó Adriaó Chaves, Chief Medical Officer of the Brazilian Marine Hospital in Asuncion, one who understands what is true yellow fever, was of the opinion that the existing disease was only 'pernicious remittent fever', and not the epidemic and contagious yellow fever.        "FRANCISCO M D'ARANJO.
"Monte Video, February 7, 1871."

There is also in the "Review" a statistical list of the mortality, which gives 13,727 as the total number of deaths from the epidemic between January 27 and June 1. I am still, however, of opinion that my estimate, that nearly 20,000 persons perished in the outbreak, is nearer the truth.

Speaking of the fever, the "Review" says:- "It is not infrequent to meet with cases of diarrh›a amongst convalescents from the disease, and, in many, abscesses in different parts of the body."

Dr, Wilde, a distinguished native Physician, in a letter to the newspaper La Republica, dated February 22, 1871, thus summed up the affair of the denials that the Buenos Ayres fever was specific yellow fever:- "It follows, then, that of all those who have denied that this fever exists, not one has found himself in presence of a patient attacked by it."

So great was the dominion of the epidemic in this city during a certain period, that its organs sallied daily from the press, and the "Bulletin of the Epidemic" and the "March of the Epidemic" well employed the gamins for some time.

The municipality are said to have disoccupied the house first affected in the city. It is to be regretted that preventative measures were not carried out to a much further extent. The only way to extinguish an epidemic naturally is to separate every affected person, house, or district entirely from the rest and healthy parts. A real advance will have been made when such a plan is thoroughly carried out without consideration for social position or personal convenience.

My own estimate that about 20,000 persons perished in the plague is based upon considerations of numbers - the number stated to have fled, those remaining, the probable number unattacked, the natural mortality of the disease, the effect upon mortality of Medical attention or assistance. Other statistics only rest on probabilities, except the official, and that is too improbable.

Dr. Newkirk, who was at Asuncion during the plague, assures me that the mortality was small, and that quinine was very generally and extensively used. He believes, too, that quinine was prophylactic, and that its continuous use in a healthy person during am epidemic caused any disease that showed itself to be mild and tractable. The denial that the disease was yellow fever in Paraguay is said to have arisen from the desire of the Brazilians to disclaim the odium of having imported such a pestilence there. Amongst them quinine was largely employed.

In reference to a statement I read, that "the febrile stage furnished as a rule no extreme heat of body" (Essay on Yellow Fever issued by the United States Sanitary Commission), I must say that in the fever I observed the heat of the body was generally pungent and the stage generally well marked. Where it was not so it was always of unfavourable augury. A gentleman of my acquaintance who was attacked in the epidemic of 1858 suffered again this year.

Professor Murray writes in the Argentine Pharmaceutical Review:- "It is needless to say that the fever was first imported in 1857 from Monte Video; the second time, in 1870, from Rio Janeiro, where it remained localised in a small radius about the Rome Hotel........ It is known that some of the Paraguayan prisoners who returned from Brazil to their country last year had the fever, and that many of them died. There is no doubt that they carried the germs of the disease from Brazil....... Afterwards we learned that the disease had invaded the town of Corrientes, and that it was very fatal, from want of assistance the mortality ascending, it is said, to 25 per cent. of the entire population....... Nevertheless, the authorities here did nothing, a quarantine only existing in name........ We may be perfectly certain that the disease has been imported into this city, since it began in the parish of San Telmo, where according to general report, the person who came sick from Corrientes went to lodge."

The following facts have come to my knowledge:- Of eleven practicantes (dressers) of the Hospital de Hombres, eight took quinine in doses of three grains daily; all these had the fever of a benign form, three took no quinine; these had the fever very severely, and one died. The evidence of a prophylactic influence is another proof in favour of my idea of the nature of yellow fever.

I desire to express my great indebtedness to the authorities of the lazaretto of the city; to the Physician, Dr. Don Pedro Mattos, and to his adjutants, Señors Doncel, Gil and Scherer, for the exceeding courtesy and warm friendship they have ever shown me. I rejoice, too, to read the just tribute paid by the English Chaplain of Legation to this institution, which so well performed its duties to all nationalities.

I have tried to draw attention to the fact of there being a period of remission in specific yellow fever between the first and third stages. The third stage appears to me an intensification of the first, in that there is not only an absence of fever, but a greater expression of such a pyrexic state in adynamia. Still arises the question whether the bleedings of the third stage are not the expressions of local congestions, relieving themselves at the point elected from impotence of the capillary system, to arrest sanguineous loss. The remarkable effect of the ergot of rye in restraining these losses lends colour to the idea.

The influence of quinine to arrest malarious phenomena is generally explained by asserting that it is the antidote to the poison in some such way as antidotes are understood in chemistry. Rather would it seem to me that quinine in all these diseases is an antidote to the effects of the poison on the system. Its prophylactic action seems to prove that, as a fortifier of the nervous system, it renders us less liable to succumb to the malarious poison.

The malarious poison evidently produces a profound impression on the nervous system, as its primitive expression or primary effect; undoubtably, the essential poison of yellow fever produces also its primary effect on the nervous system, and in this allies itself with the malarial poison, and thus far is like it; and for the effects of both miasms quinine may be a remedy, although their essence may mutually differ in intimate nature, addressing itself to the results of the poisoning and not to the poison itself; yet its effects are similar - so the nature of malarial and yellow fever poison may not be too different - a question of intensity, perhaps, only such an intensity as shall imply portability and tenacity of existence in the poison. Attending to the prominence of nervous phenomena in these diseases, it would be quite philosophical to entitle them nervous fevers - fevers whos notable effects are lesions of innervation.

The following statement in Dr. Metcalf's essay for the Unites States Sanitary Commission well exhibits the importance of studying the connexions between the different forms of fever:- "In proportion as countries previously malarious are cleared up and thickly settled, periodical fevers disappear; in many instances to be replaced by typhoid or typhus." I believe Dr Oldham denies the existence of malaria, and attributes its proclaimed effects to be simply the results of chill. I have not seen his work, but hope to be able to obtain it. Such an idea was very present to me during my military service in Paraguay. I have previously stated that the Paraguayans call their remittents colds, and often cure them with such simple remedies as suffice for a common cold; still, I cannot help believing that there are malaria- miasms - specifically affecting the constitution of dwellers amongst them, and giving to all diseases occurring in such localities a particular impress of paludism; my idea rather being that the common cold in a malarious district is not different from that occurring in a non-malarious locality, except in that it is produced in a malarious constitution, and thus is so different that it appears another disease.

The newspaper La Republica publishes a mortuary sheet, in which former statistics are amended and the total number of deaths stated at 17,084. I am told that these data are obtained from the municipal authorities. Their only merit is a greater approach to correctness than the former list. More one cannot say of them. Some of the statements in this publication induce me to add a few more observations:-

"Three hundred and fifty gravediggers respected by the fever" The cemeteries are situated on the outskirts of the population. Coffins were exposed for many hours before being interred, from the press of work.

"Seventy-two deaths in one conventillo." Lodging-houses; fever dens.

"Mustard at 10s. a pound." Mustard baths and sinapisms excellent.

"The president flies." A gross calumny. Mr. Sarmiento, although naturally residing outside, came regularly to the city during the worst of the epidemic. "Medical men bolt." "The sick all condemned (sic) to be sent to the lazaretto." The best of measures, unfortunately not fulfilled. "Provincial Government at its post." It appears that the disease has existed in the city for a period of six months, the first half of this year 1871; fortunately we are now in mid-winter, and may hope that, as heretofore, the disease will be thoroughly extinguished.