Observations on Intermittent Fever."

PROF. DUCHEK, of Prague, finds, in Intermittent Fever, the spleen always enlarged before the period of the intermit tent proper. It is easily distinguished from typhus, for in the former we find a light yellow covering of the skin, and the splenetic tumor grows more rapidly. Patients sometimes escape the fever during their sojourn in a malarious country, and are only attacked when they come to a more healthy place; but even during their first paroxysm, the splenetic tumor can be felt. Even the foetus may be attacked, when the mother suffers from intermittent fever. We saw such a case, where the mother suffered from a tedious quotidian, with enlargement of the liver and spleen. In the cadaver of the child, we found the skin of a dull color; the cavities of the chest and abdomen full of yellow water; the lower lobes of the lungs compressed, the upper ones containing very little air; the liver enlarged; the spleen considerably enlarged, reaching below the navel, and weighing two

ounces.

Our experience is, that not the paroxysm, but the change in the spleen, is the first symptom of intermittent; and as long as paroxysms increase in time and intensity, the spleen will keep on enlarging. The percussion of the region of the heart gives, during the paroxysm, a more wide-spread, dull sound, than in the normal state; and we can hear systolic vesicular murmurs in the ostium ven. sin., and the ostia of the art. pulm. and aorta.-Med. Investigator.

Pure Air an Antidote to Puerperal Fever.

FAN epidemic of puerperal fever broke out in the lying-in asylum of Vienna, during the winter of 1865. Prof. Stamm proposed to keep the windows open day and night, considering it safer to expose his patients to the danger of catarrhal attacks, than to the poison of puerperal fever. The presiding officer, Prof. Carl Braun, objected at first to such unusual treatment in mid-winter, but as the death-rate increased, he allowed a careful trial; and as no evil consequences followed, he allowed the opening of the windows during day-time. The epidemic soon ceased; but during March, new cases appeared, and although it raged during March and April, we could congratulate ourselves to have saved every case, except the first one, by strict adherence to fresh air.-Medical Investigator.

Therapeutic Value of Oxygen.

We find it in the 15th August number of the Bulletin de Therapeutique, summed up at the conclusion of a long and admirable essay by Dr. Constantin Paul, as follows:

1. Oxygen is not a poisonous gas, and as much as thirty litres of it a day can be inhaled for days, without producing any ill effects. Only after two or three weeks, does it commence to produce feverish symptoms.

2. Oxygen is a precious resource in cases of asphyxia, especially when this condition is the result of accidents.

3. It is a valuable remedy in attacks of nervous asthma, and even in humid asthma it will be found beneficial.

4. In phthisis, oxygen has not yielded the good results hoped from it. It gives often temporary relief, but exacerbations follow, more severe, perhaps, than when it is not used. At best, it is but a palliative measure.-Med. and Surg. Reporter.

Ignorance in the Medical Profession.

Two courses of lectures are considered, in our country, sufficient to impress the brains of young men, many of them still in their fourth or adolescent age, with enough medical lore to feed their minds through life.

These courses can be condensed to such a degree, that a person nine months (it takes more time to instruct an apprentice shoemaker) from the time he first thinks of studying medicine, may have a diploma from a State University, proclaiming that in the opinion of the faculty, he is sufficiently learned in the science and art of medicine, to practice upon any person ignorant enough to allow him to do so. The observance of the obligation with which the diploma is conferred and accepted, can be judged of by the fact that the most prominent objeet in the offices of many homoeopaths, is the diploma of the university at which they were graduated, and from the teachings of which they seceded after obtaining titles. The greater the number of students at the present low prices, the larger the income of the professors, and the less the amount of knowledge obtained by the students. The status of the profession is being lowered each year, by the admission into its ranks, of men who are coaxed to come from their shops and ploughs by the underbidding of schools that desire to improve their incomes and names, not by the knowledge imparted to, but by the number of their alumni.

To speak of the ignorance of a profession is likely to arouse the combative natures of the members thereof, and may produce feelings not conducive to impartial examination of the subject; still, in order to banish ignorance, it becomes necessary to expose it, and we respectfully submit a few statements (not new) to the notice of those who are capable of observing the persons who treat, as well as the patients who are treated.

For our own amusement, we have divided physicians into three classes, the practical, theoretical, and stationary, or retrograding.

The practical start with the determination to be eminent as physicians, they search for practice of all shapes and kinds, seize every opportunity to add to their stock of special and general information, keep up with science by their observing and imaginative powers, and the use of the labors of others, are prepared for each and every emergency, and are the most successful practitioners in curing disease and in making fortunes.

The theoretical are hard students, devoted to the study of physiology, chemistry, and the kindred inductive sciences, most frequently are, or should be, teachers, they being the architects producing the laws that the practical men, as artists, apply.

These two classes are the ornaments, and will compare. favorably with the learned men of any profession. They are far outnumbered by the stationary or retrogrades, men who make it a boast that they "have not opened a medical book since they graduated," in the hearing of their patients and friends; use without stint or discretion the few pedantic phrases and authorities which they may have absorbed, give "cawlomel and jawlap," or the "liver being out of order,' prescribe blue mass, followed by salts and senna; when in company with physicians, seldom speak of medical subjects, or if they do, it is with a mingled leer and nudge of the elbow suggestive of being behind the scenes. These are the skeptics-men, who, like Crispino, doctors in spite of themselves, pass through their medical lives upon the sentences, "I think I would give a little paregoric-a small dose of oil," "the patient becoming feverish, you might give a little salts to cleanse the blood." These persons, like the homeopaths, do no good; on the contrary, much harm, by the loss of valuable time in the treatment of disease-men who are specialists, not with regard to the disease they treat, but with regard to the medicine they use, who affirm that with stim

or,

ulants they will cure all disorders, following their theory by giving ten ounces of brandy in cases of phthisis, but think nine and a half will do in pneumonia.

We suggest to the American Medical Association that these specialties be among those ventilated at the next assembling. Men who studied thirty or forty years ago-were well read in those days-could tell you that Macintosh bled in intermittent fever to eighty and one hundred ounces, and if that did not cure, to repeat venesection. (Scotchmen are proverbially hard to kill.) They believed it then; they believe it now. We have seen, within the last three years, extensive blood-letting in chronic diarrhoea, and have known of phlebotomy in consumption; the patients were not Scotchmen.*-Medical and Surgical Reporter.

Tetanus successfully treated by Atropia.

DR. G. OLIVER in the British Med. Journal details the following case:

A healthy-looking lad, aged fourteen, was seized with lock-jaw and severe pain in the cervical and dorsal regions, with fever, a few days after jumping from a coal-wagon. On my visit (fourth day of symptoms), I noted well marked risus sardonicus; incisors separable for less than half an inch: masseters rigid; cervical and dorsal vertebræ arched forward; sterno-mastoids and muscles of back rigid; abdomen flat and hard; legs and feet rigidly extended; tenderness along spine; arms free from tetanic symptoms; paroxysms of severe general spasm every few minutes; pulse 140; sleepless. I ordered one-sixteenth of a grain of atropia every three hours; and linimentum belladonna to be well rubbed over the spine and rigid muscles every six hours.

Within twenty-four hours, the physiological action of atropia showed itself; then the clonic spasms became less severe, and of shorter duration; and the tonic rigidity gave way, first in the legs and neck, then in back, and last of all in abdomen and masseters. On the sixth day of treatment by atropia, rigidity of the masseters alone remained. He was kept under the influence of atropia for three weeks. He then quickly and completely recovered his usual health under steel and quinine.

* Our old school friends will occasionally make some vulnerable admissions. As this applies to their own school they will pardon us for reproducing it in this Review.-[Ed. R.]

It is said by Brown-Séquard, that belladonna reduces congestion of the blood vessels of the spinal cord and its membranes; that its principal physiological action is "spinal anæmia." I believe that the tetanic symptoms in this case depended on an excitability of the spinal cord, probably caused by "spinal congestion "--a derangement of the vasomotor nerves of the cord and its membranes, which allowed more blood than normal to circulate through the contents of the spinal canal. If so, we have the rationale of the therapeutic action of atropia in this and allied cases.

Granular Inflammation of the Urethra.

THE most important revelation of the endoscope is the complete establishment of the fact that the mucous membrane. of the urethra, like that of the eye, is subject to a granular inflammation, and that this disease constitutes the true lesion in many chronic gonorrhoeas. Some years ago experiments were made on women hired for the purpose, which showed that granular ophthalmia might be inoculated into the urethra and there produce a disease which could not be distinguished from chronic gonorrhoea.

In fact, true chronic gonorrhoea is a granular inflammation identical in nature with that which produces granular inflammation of the eyelids, of the cervix uteri, and of the larynx; and one may be produced from the other by inoculation.

When granular, or true chronic gonorrhoea exists, it has no tendency to spontaneous recovery, but will last an indefinite number of years unless properly treated, and will communicate contagion as long as it continues. This disease often persists long after the patient believes himself or her self free from the clap, and hence the frequency with which men contract gonorrhoea from females whom they believe, and who believe themselves, to be free from disease. The chief use of the endoscope is in the diagnosis and treatment of this disease. Granular inflammation of the urethra, like that of the eyelids and cervix uteri, is extremely slow and obstinate, sometimes requiring several months or even a year or more to effect a cure. As long as the endoscope shows any granulations, the disease and its contagiousness continue. During all this time the discharge may be scarcely worthy of notice, and not at all purulent, but a slight irritation serves to arouse the granulations into activity, so that