In all febrile diseases with a hot, dry skin, hot breath, and thirst, the sedative influence of cold is strongly indicated. it may be applied by means of cool fresh air inhaled into the lungs, which in general proves grateful and refreshing. For this purpose the air of the chamber should be frequently renewed, and the temperature not allowed to exceed from 70° to 76° F., according to the season, if the weather permit. Care, however, should be taken to guard the body against undue exposure to cold, and it should therefore be kept covered, especially when the surface is damp, and the patient disposed to chilliness.

Cool drinks are still more refreshing; and small sips, frequently taken, of iced lemonade, orangeade, or pure iced water, should be permitted in all cases, when desired by the patients under the above circumstances. When the mouth and fauces are hot and inflamed, small pieces of ice may be held in the mouth and allowed slowly to dissolve; and, when gastritis exists, with burning heat of stomach, and perhaps vomiting, the ice may be swallowed undissolved, as before recommended in the same affection occurring distinctly.

Externally, too, cold may often be applied with great advantage. Dr. Currie, of Liverpool, distinguished himself by introducing into use this measure, not only as a palliative, but as a cure for fever. His method was to strip the patient naked, and, seating him in a tub, to pour over him four or five gallons of water from 40° to 60° F., and to repeat the process two or three times, or until rigors should come on; after which he was to be wiped dry, and put immediately into a warm bed. Reaction soon took place, attended with diaphoresis, which was sustained by the free use of tepid drinks. The remedy thus employed operates not only by the depressing influence of the cold, but in several other ways also; as by a shock on the nervous centres calculated to interrupt the associated morbid actions, by the reaction which follows, and by the promotion of sweating. But, powerful as it is for good when properly used, it may, under other circumstances, be productive of serious injury. Dr. Currie, therefore, gave some rules to guard against the abuse of the remedy, which are highly judicious. The temperature of the body, as ascertained by a thermometer under the tongue, should be at least 96°, the skin should be considerably hotter than in health, and perfectly dry, and there should be no sense of chilliness present, and no existing internal inflammation, especially of the chest. in women, moreover, the measure should be avoided during the menstrual period, and in the advanced stage of pregnancy. it is usually best that the hair of the head should be removed before the affusion. Some fevers may be much benefited, and even cut short by this remedy. Such are the proper typhus, and the miasmatic remittent or bilious fever. it might possibly also prove serviceable in yellow fever. it is inapplicable to enteric or typhoid fever and the exanthemata; to the former, because the disease cannot be cut short by this or any other measure, and, moreover, in consequence of its complication with or tendency to internal inflammation, especially bronchial; to the latter, because there might be serious danger of an introversion of the irritation, which might fix with fatal violence on some vital organ. in cases to which it is applicable, if in their advanced stage, the temperature of the water should not be more than 20° below that of the surface.

In all febrile diseases, however, when the skin is very hot and dry, and no sense of chilliness exists, the application of cold by sponging with cool water may be employed without hesitation; due care being taken to graduate the temperature to the sensations of the patient, and the extent of the application to the degree of vital force. in the exanthema-tous fevers, moreover, the disposition to retrocession must be taken into consideration; and, when this is liable to happen, the remedy should be used with caution. When strongly indicated, the sponging may be applied over the whole body; in other cases, it may be confined to the extremities and the face. The temperature of the water should be such as to be agreeable to the patient, and never so low, under these circumstances, as to produce general chilliness or rigors. A few degrees below the temperature of the surface, say from 10° to 20°, would be quite sufficient.

In the headache or delirium of fever, or whenever determination of blood to the head is observable, cold water may be applied to the scalp in the manner already described. (See pages 9 and 10.) d. Nervous irritation.

In spasmodic affections of different kinds, cold has been found useful; as much, however, probably by its nervous stimulant property, or shock on the nervous centres, and by its indirect tonic powers, as by its purely sedative influence. Still it would seem to be clearly indicated, in reference to the last effect, in disorders consisting in irritation or morbid excitement of the nervous system; as it unquestionably acts as a direct sedative to this as well as the arterial system, when the first excitant shock of the sensation is passed. its usefulness in convulsions has been already mentioned.

Spasm of the stomach will sometimes give way to the sudden application of cold to the epigastrium; and I have seen spasm of the bowels which had resisted every other measure that I could employ, yield immediately to a stream of cool water, poured out of a pitcher from the height of three or four feet upon the abdomen, while the patient lay upon his back on the floor. The measure may be tried also in obstinate spasms of the ureter, hepatic ducts, bladder, and rima glottidis, after other means have been exhausted.

The powerful sedative action of cold affusion, and of the cold bath, at a temperature between 40° and 50° F., has been repeatedly resorted to with success in tetanus. The vital actions are greatly reduced; and, in this state of reduction, the spasms relax. Should they return, the same measures should be repeated, at proper intervals; care being taken not to depress the powers of the system too far. After being removed from the bath, the patient should be placed in bed, wiped dry, and stimulated, if necessary, by carbonate of ammonia or hot spirituous drinks. Great caution, however, is required not to depress the patient below the point at which reaction can take place. immediate death has resulted from the use of the cold bath in tetanus.

In various conditions of hysterical disease, cold water may be used to calm the nervous excitement. irregular contractions of the involuntary muscles, various internal spasms, palpitations, epigastric uneasiness, flatulence, etc., may often be relieved by cold water administered by enema, or applied by a sponge to the epigastrium, the chest, or along the spine, or by immersion for six or eight minutes in a cool bath, between 60° and 80°.

In the paroxysms of maniacal violence, the cold shower-bath, or affusion upon the head of the patient, is one of the most powerful methods of producing calmness. The application should cease with the violence of the excitement; and may be renewed with its renewal until the patient is permanently quieted. Close watching is requisite to prevent too great depression. One minute is often sufficient, and five or six minutes should be rarely exceeded when the water is very cold.