A. J., aged 30, strong, muscular and hitherto healthy sent for me. He had been exposed about eight weeks before, while on the isthmus of Panama, to unusual vicissitudes of weather and three weeks after he left Panama had sickened with chill, fever, vomiting, &c. more or less severe, which however he succeeded in suppressing by large doses of quinine so as to be able to travel for a few days at a time. Three days before I saw him he was taken with an unusually severe chill followed by high fever and alternations of chill and fever, with severe constitutional symptoms, which continued notwithstanding large and repeated doses of quinine, until I found him in the following condition:

Though still quite stout he had lost flesh greatly, having decreased in weight thirty pounds during the last month. His face was of a dusky red hue, hot and dry, eyes injected, dry, and ferrety, the pupils contracted, with a very restless anxious expression. The patient had constant thirst though satisfied with a single swallow of water at a time. The stomach was excessively irritable — drink was rejected as soon as taken; a profound disgust for food of all kinds. The tongue was covered with a thick brownish coat and felt to the patient dry, though not actually so. When protruded, the tongue trembled and was moved involuntarily back and forth, in spite of efforts to keep it still. The hands trembled excessively when held out and the patient complained of indescribable weakness and prostration. Nevertheless there was uncontrollable restlessness, it being literally impossible to remain for more than an instant in one position — the recumbent posture was intolerable — alternations of chill and heat, partial and fugitive in character, were experienced, each lasting about fifteen minutes, the heat yielding for a few moments to a partial clammy sweat which was soon succeeded by chill again. There were dyspnea and short, dry cough. The spleen was much enlarged and dull on percussion. During the last two nights the patient had been unable to sleep at at all, but had been exceedingly restless and uncomfortable, tormented by thirst. The pulse was 140, very quick, small and wiry. The head was confused and I found the sensorium much clouded, it being difficult to get definite answers to my questions; there was however a constant effort to give expression to a sense of great uneasiness and vague apprehension of severe illness.

No one who has been at all conversant with Panama Fever could fail to recognise the gravity of the above. I expected to have a long and perhaps a doubtful battle with the disease and proceeded accordingly to make arrangements for an indefinite sojourn on the part of my patient who was not a resident of this place. From the symptoms as detailed there could be no doubt of the prescription required at the moment. The excessive prostration conjoined with the great nervous and vascular erethism, the irritability of the stomach, the great thirst, satisfied for the moment by a small quantity of water — the intermingled heat, chill and partial sweat, presenting at no time a definite paroxysm of intermittent, along with the dyspnea and anxiety, and the peculiar pulse, weak and yet excited, made it a matter of course that I should give Arsenicum, which, as the indications were so clear that the selection of the remedy could not be a matter of doubt, I gave in the 200th potency, deeming this a very fair case, both as regards the clearness of indication and the severity of the disease, for the demonstration of the power of the high potencies. I gave at four p.m., a powder of Sac. lactis containing two globules of Ars.²⁰⁰ to be taken dry, and to be followed by a similar powder every four hours.

The following day I found that my patient had slept three hours the night before — his stomach, no longer irritable, tolerated beef tea and toast, the chills and heat occurred about once in four hours, lasting for a few moments only; cough and dyspnea had disappeared. Prostration still excessive, restlessness, moderate, intelligence good, tongue and hands less tremulous. Ars.²⁰⁰ as before every six hours.

The third day. A better night, no chills or heat to day, strength increasing; no restlessness. Ars.²⁰⁰ every eight hours.

The fourth day; slept well last night, feels like walking out; appetite good, tongue clean. Sac lactis.

The fifth day feels quite well and strong.

The next day he resumed his journey. In such a case one would apprehend a relapse after the expiration of one, two or three weeks. I have made especial enquiries respecting my patient and find that nothing of the kind has occurred. It is three months since I prescribed for him and he has steadily gained strength and flesh and is to all appearance well.

Newburgh, N. Y. DUNHAM.