compounded, may now be regarded as established. I do not mean that the causal microbes of typhoid and malarial fevers are produced by a micro-organism, whether known or unknown. And it is worthy of notice that Woodward, who was an opponent of the germ theory of disease (he died before the greatest triumphs in this department of pathology were achieved), should have selected for this hybrid a name which will probably need no emendation, when our knowledge of its pathogenesis is complete. The terms malaria and typhoid have been so long employed. that it is altogether probable, that whatever microbes may be found to be the fons et origo mali of these diseases, they will receive names that will associate them with the familiar terms. That the name typho malarial fever has been grossly misapplied, is no argument against it. I have known it to be applied to remittent, simple continued, and to uncomplicated typhoid. Almost the only fever occurring in the section of country in which I practice, is simple continued; a fever that rarely presents any of the prominent symptoms of typhoid, and yet it is very generally diagnosed as typhoid or typhomalarial That typho-malarial fever must be comparatively rare in most sections of country is evident, for it cannot be often that the two causes of the hybrid co-exist. In most places where malarious fevers prevail to any great extent, typhoid is but rarely found; and malarial fevers are, as a rule, uncommon, where the conditions favorable to the development of typhoid exist.

Typhoid shows a partiality for northern latitude and increases with the growth of population. Malaria, on the other hand, finds its home further South, and declines with the increase of population. The means by which the contagion of typhoid is spread, multiplies as the population of towns and cities increase. Whereas, the drainage and other sanitary reforms necessitated by the crowding of population, tends to stamp out malarial fevers. Hence it is exceptional, in many parts of our country to find a case of typho-malarial fever, except in those subjects who have recently removed from a malarial district to one in which typhoid is endemic, or where large numbers of people are suddenly thrown together, or where places are undergoing the transition from malarial to typhoid localities; a typical example of which is to be found in the sanitary history of Chicago, an epitome of which, by DR. N. S. DAVIS. I have already quoted. It is true that the autumnal typhoids are frequently complicated, to some extent, by malarial influences, and it is a matter of common observation, both in Europe and America, that there is a marked departure from the ordinary fever curve, in a large percentage of the typhoids, occurring at this season. The mortality is also higher in

the typhoids of Autumn, but it is not often in these cases that the strongly-marked malarial symptoms are seen, and the propriety of classing such cases as typho-malarial is questionable, at least. It would be better, from a practical point of view, to restrict the use of the term to those cases in which the malarial infection is of such intensity as to markedly confuse the ordinary typhoid picture. Used in this restricted sense, and with the understanding that the name is not intended to designate a specific disease, but merely an intermingling of the causes of two diseases, it is a term of great practical convenience and importance to the military physician, to the general practitioner and to the medical statistician. Or, to use the language of the lamented AUSTIN FLINT, SR., whose.great learning, wise conservatism and long experience constituted him at once the Nestor and the Ulysses of American medicine: "The general favor with which the term typho-malarial has been received, and the readiness with which it has come into vogue, show that it expresses a pathological doctrine consistent with clinical experience." *

A WELL-NIGH FATAL CASE OF CHLORO. FORM NARCOSIS.

BY H. R. RANDALL, M. D., WINONA, MINN.

On the 26th of November, I received a note from DR. WAHL, requesting me to call immediately at a certain house and bring chloroform. Responding at once, and arriving at the house, I was introduced to the patient, Mrs. P., a robust woman of good physique, apparently accustomed to health, and aged 21 years. She gave the following history:

Menstruation which should have taken place three weeks before, did not occur. She had observed no other symptoms of pregnancy and had been in good health until the evening of November 22nd. At that time she was seized with bearing down pains which had been partially controlled by opiates until the present time. There had been occasional escape of blood clots from the vagina-those which last escaped, having a fetid odor.

Examination revealed an enlarged uterus reaching to within about two and one-half inches of the umbilicus, filled with blood and the partially decomposed products of gestation.

It was proposed to anæsthetize the patient and empty the uterus. She had previously taken chloroform upon four different occasions with no ill effects. Though the pulse was only 60 per minute, it was full and strong, and careful examination revealed no contra-indication to the use of chloroform.

* Memoirs U. S. Sanitary Com., N Y., 1867, p. 214.

The patient, clad in nothing but a loose dress, was placed on a table in recumbent posture and the anesthetizing was begun. After about five or six deep inhalations, breathing suddenly ceased. A hasty glance showing that the tongue was not obstructing the air passage and the pulse continuing strong I removed the cone and awaited a moment the resumption of respiration, when, without any warning, the countenance undergoing no change of color, radial pulsation suddenly ceased.

The patient was immediately drawn over the head of the table, and while the head was hanging down we attempted artificial respiration alternately elevating the shoulders and then lowering them and compressing the chest. But there was neither pulse nor respiration, the patient continuing limp and apparently lifeless.

The outside door being near by was opened, admitting air at a temperature of about-10° F. Seizing the patient I carried her to the doorway and threw her backwards over my knee her head hanging down to the floor. Then as we slowly raised her shoulders she emitted a low respiratory groan,—and then the rest of us breathed too. Following this up with ammonia, flagellation with a wet towel, etc., she was soon beyond all danger.

Respiration was suspended probably as much as two minutes; the pulse about fifteen or twenty seconds less. The operation of empty. ing the uterus was performed under morphine and the patient is now almost well, having had no untoward symptoms.

The above adds one more to that immense catalogue of cases which illustrates the dangers of administering chloroform even when no contraindications to its use can be discovered previous to its exhibition; but as a case of restoration from chloroform narcosis, in which heart failure has been preceded by-suspension of the respiratory function, it is, doubtless, one of a comparatively small class.

Correspondence.

SHALL WE REGULATE THE PRACTICE OF MEDICINE BY LAW?

The article in the AGE of November 10th ult., by J. V. STEVENS, M. D., of Prairie du Sac, Wis., must sound to every true physician as a plea for quackery. Perhaps the doctor did not so intend it, but many of the statements contained therein are certainly such as to convey that impression, and are at variance with the spirit of the age, as pertaining to the true physician, as well as palpably void of argument.

In the first place, in regard to the medical bill for the regulation of the practice of medi

cine in this state, which was before our legislature last winter. To this he refers, by saying that it was defeated because of the almost unanimous protest of physicians of all schools. I beg leave to deny the assertion. There were many other reasons why the bill was defeated, two of which I mention as having more force than others. Of course, we do not deny that the bill had its objectional features, but the homeopaths opposed it bitterly because it did not, as they claimed, give them chances with the regular school.

The second great reason why it was opposed, was the fact that it aimed at reform, the same reason that has always stood in the way of progress everywhere.

AS DR. MULHERON says in his editorial in the AGE, April 25, "the bill fails to deal with the question which, in our opinion is the fons et origo of the evils which it is calculated to correct. It accepts the diplomas of medical colleges as a guarantee of the fitness of their possessors to practice medicine." Those who opposed the bill on these grounds, did so because it did not seem to reach up to the urgent demand of the age in the regulation of the practice. Men who opposed it for these reasons are generally ready to accept of legislation no matter how rigid its demands, and we are not to suppose that men who have been so thorough and rigid in their own preparation, have done so, or require the same in their brother practitioner, from a purely selfish standpoint, as DR. STEVENS Would have us believe.

What a grand condition of society would we have if the members of our grand and noble profession were as hypocritical as DR. STEVENS implies, when he asks "Why should physicians be so anxious to protect the 'dear people' when they (the dear people' I presume he means) are satisfied as it is? I strongly suspect that a great many of the supporters of these measures are fully as selfish as philanthropic and do not relish the success some of these illiterate M. D.'s are having in combatting disease in their locality and thus dividing the dollars with them?" I think the history of the medical profession will prove, and any person who reads and will honestly express a candid opinion, will concede, that no class of men have been more unselfish in their efforts to alleviate the sufferings of humanity, or elevate and better the conditions of human society than physicians; grand, heroic examples of self-sacrifice are made every month and year for the welfare of ignorant, unprotected human beings, and any number of examples can be cited. The medical profession has made itself renowned by its untiring, unselfish devotion to the needs of suffering humanity, and any one who can stand up boldly and affirm, as DR. STEVENS has done in his article, that the motives which prompt medical men, to

agitate reform, or seek the good of the profession by legal enactments, are selfish, and their show of philanthropy is thus to be called in question, can certainly congratulate himself on the possession of plenty of cheek, but can boast of very little wisdom, or even charity for his fellow men. Of course men may have questionable motives sometimes, but to make a bold unqualified statement as the doctor has done, is certainly worthy of criticism.

But the question at issue, whether prompted by honest or dishonest motives, remains the same, and in the light of the present age, especially in this proud State of Michigan, where the public school system boasts of completeness, and where light and wisdom shine upon every hilltop, and where the law demands a reason for action in school-teacher, lawyer, dentist, and druggist, who can deny that some means should be adopted by which a profession so responsible as that of medicine should be regulated? and who can devise any other way than by legislation? I think, on careful, candid, reflection that all must be forced to acknowledge the urgency of the demand, and when a professional M. D. comes out in condemnation of the men and methods sought in carrying on this work; when he even goes so far as to condemn the agitation of regulation from year to year, and without reason or common sense seeks to impugn the motives of the medical profession, it can be safely set down that there is something fearfully wrong in that man's make-up or education.

It doesn't look well in any man, especially a "self-styled, modern physician," to attribute a dishonest motive to men who would hail a better day for medicine and a greater good to the people, no matter how much it might interfere with themselves. That which seeks the greatest good to the people, and must also redound to the benefit of the profession, is to be hailed by all true men; if it cuts such men as you and me out of the profession, so much the better, for if we are unworthy to remain there, we ought to go. The grand profession to which we belong is amply worthy of demands as high as these.

DR. STEVENS asks, "What guarantee can we have that these boards will be any more capable or incorruptible than the faculties of medical colleges? Is it consistent with American liberty to compel a man to be dependent upon a few interested persons in a State to say whether he shall have the right to enter that State and engage in the pursuit of happiness by honestly trying to earn a livelihood as a doctor? Did the possession of theoretical knowledge of itself ever make a good doctor, or knowledge of books alone make a teacher, or lawyer, or pharmacist, or preacher ?" Now, I am, and no doubt hundreds of medical men all over the country are sorry to see such deplorable stuff

coming from one who signs himself M. D. Just such arguments (?) as these are the curse of the age, and are more effective in their influence against reform than they deserve to be. Does DR. STEVENS say it is unconstitutional to require an examination of the teacher in our public schools by a "few interested persons ?" Does he affirm it to be wrong, and an infringement of personal liberty, to require candidates to go before a board appointed by one man (the Circuit Judge), who shall examine the candidate and say whether or not he shall become a member of the bar? Is it the doctor's opinion that there's anything criminal in requiring druggists and dentists to subject themselves to a rigid examination by a regularly constituted board, which every one of them must do in this State, unless he can produce proper credentials for his authority to practice? I would like, also, to ask the doctor, what is the reason that hundreds of quacks crowd themselves into our State just as soon as one of the adjoining States enact some law of protection against these suckers? And why is it that every winter that these bills seeking to regulate the practice in this State are before the Legislature, these fellows hold themselves in readiness to skip just as soon as such law shall come into force? Men who are up with the times, and have been faithful in preparing themselves to practice, no matter whether old or young, or where they may have gotten their preparation, whether at home by their own fireside, or in one of the most popular medical colleges, do not usually sustain the relation of quack to our profession, and nobody wants to deny that there are some old men in our ranks who, be it said to their credit, have kept pace with the age, and who to-day, while they may not have seen the inside of a medical college, are living epistles, and sparkle with brilliancy in thought and speech. But how many men of this kind do not actually stand in the front ranks for reform? Such men are bright enough to see the necessity of, and are aggressive enough to fight for, reformation.

I wish, in conclusion, simply to refer to one more of DR. STEVENS' last sentences viz.: "Let us trust that a discriminating public will refuse to employ those not prepared or worthy and thus compel the right ones to abandon our noble profession." DR. STEVENS must be as he admits, a young doctor; he must be very young, without experience, or else he lives in a locality, the duplicate of which for enlightenment and well-educated people, etc., etc., is not to be found in Michigan. Either this, or else his credulity leads him to the exercise of greater faith in humanity than most of us can have who have times without number seen people to whom we gave credit for some degree of intelligence, trotting off like sheep to the slaughter, after the most flagrant quacks who

sound their own praises in the columns of the newspaper.

Perhaps DR. STEVENS has none of these follows to deal with over in Wisconsin. One thing is certain, and I think my medical brethren of the State of Michigan, will bear me out in the statement, that if medical men wait until this enlightened "discriminating public" bring about reform and protection they will forever, like willing slaves, take up their burdens and plod along in the rear, while this festive gang of regaliaed quacks will continue to gull and deceive this " discriminating public," and put their wealth into fine properties, and flaming handbills covered with lies, but swallowed down with no compunctions whatever by the "discriminating public." FRED R. BOYD, M. D.

CEDAR SPRINGS, Mich.

A FEW NOTES ON THE THERAPEUTIC ACTION OF CERTAIN DRUGS.

Euphorbia Pilulifera, Fluid Extract, was tried by me during 1885, in a very obstinate case of asthma, with associated bronchitis and emphysema. The first effect was a seeming triumph over the symptoms, but nothing, in this case, so availed as potassium iodide, tincture lobelia and potassium bromide, with tincture columbo as a vehicle. Euphorbia pilulifera seems to be narcotic, and it is capable of good in uncomplicated cases. No further trial was made with the drug.

Grindelia Robusta, has upon trial been found very trustworthy in capillary bronchitis occurring in children.

Boldoa Fragrans, is a drug whose only disadvantage is its nauseousness. I have emploved it with most gratifying results in cases of atony of digestive organs, debility, neuralgia and ague cases. In these last no combination has succeeded as:

Tinct. nuc. vom., 3 ss.

Alcohol dil., q. s. ad. 3j. M. Dose, gtts. x.

Stigmata Maidis, I have found inferior to other drugs employed in the same sphere. Buchu serves me well. I do not claim to have tried it but in a very limited number of cases. Perhaps it may be truthfully said that a physician's greatest embarrassment not unfrequently lies in the richness of his therapeutic resources, an embarrassment he can overcome, however, by successive trials of other drugs, with asserted claims and similiar range of action. I have frequently heard Stigmata Maidis spoken of lightly. I am personally acquainted with a man who has a diseased

The following aphorisms were discovered by a correspondent of the Canada Lancet, who ascribes them to AMEDEE LATOUR:

1. Life is short, patients fastidious and the brethren deceptive. 2. Practice is a field of which tact is the manure. 3. Patients are comparable to flannel; neither can be quilted without danger. 4. The physician who ab sents himself runs the same risk as the lover who leaves his mistress; he is pretty sure to find himself supplanted. 5. Would you rid yourself of a tiresome patient, present your bill. 6. The patient who pays his attendant is but exacting, he who does not is a despot. 7. The physician who depends on the gratitude of his patient for his fee, is like the traveler who waited on the bank of a river until it finished flowing so that he might cross to the other side. 8. Modesty, simplicity, truthfulness! cleansing virtues, everywhere but at the bedside; there simplicity is construed as hesitation, modesty as want of confidence, truth as impoliteness. 9. To keep within the limits of a dignified assurance without falling into the ridiculous vauntings of the boaster, constitutes the supreme talent of the physician. 10. Remember always to appear to be doing something-above all when you are doing nothing. 11. With equal and even inferior talent the cleanly and genteely dressed physician has a great advantage over the dirty or untidy one.

The Journal of Inebriety says a large gathering of philanthropists, statesmen and physicians met recently at Zurich, Switzerland, and after discussing alcohol in all its phases, declared that it is destitute of nutrient value. On the question of its value in the sick-room, no agreement was reached. The Medical Record justly remarks that a Congress whose labors resulted in an agreement on such a physiological untruth, and in a disagreement on an evident clinical fact, needs, apparently, the infusion of a little intelligence into its members and managers.

The Medical Age.

A SEMI-MONTHLY REVIEW of medicine.

JOHN J. MULHERON, M. D., Editor.

-PUBLISHED BY

GEO. S. DAVIS, Medical Publisher, Box 470.

DETROIT, MICH., DEC. 10, 1887.

Editorial.

TREATMENT OF TYPHOID FEVER.

Our correspondent, DR. KETCHUM, of Palo Pinto, Texas, takes occasion to criticize the treatment of a case of "unusual form of typhoid fever" as outlined in a recent note in THE AGE. His criticism, boiled down, is a reflection on the somewhat expectant course of the treatment pursued. DR. KETCHUM is, evidently, one of that very practical kind of men who believe it to be the first duty of the physician "to do something," and think it a perversion of their function as physicians, to turn the case over to the vis medicatrix naturæ. Far be it from us to decry the power of drugs unto the righting of disturbed function or the removal of structural charge. We admire the man who goes forth with a strong faith in drugs, but he must at the same time be an unerring diagnostician. Without great skill in this direction he is like a blind giant laying about him with a club. Without this qualifi cation for good marksmanship, his blow is liable to hit the patient instead of the disease, and unless he be sure of the drug's reaching the proper spot it were much better that he trust dame Nature to depend on her own re

sources.

This is a truism in medicine, and it tests the physician's skill quite as much to know when not to interfere, or to administer a placebo, as it does to know when to volunteer assistance. In the treatment of typhoid fever the above rule of action is very generally observed by the authorities. We have before us a resumé of the treatment of this disease followed at several of the leading hospitals of this country. In the Cook County Hospital, Chicago, it is the practice in cases seen early, and when there exists the least doubt of the diagnosis, to give the quinine in a few large doses, producing positive cinchonism, and it is frequently continued in small doses for several days continuously. Should there be any doubt that the bowels have not been thoroughly cleaned out a laxative dose of calomel is given. No patient should be allowed to pass more than forty-eight hours without

an evacuation of the colon, to effect which an enema of warm water may be given. In cases of diarrhoea full doses of salicylate of bismuth are given, with small doses of deodorized tincture of opium. Alcohol is given only in serious prostration, with weak pulse and rapid heart. Nux vomica or strychnia are given in the same conditions.

High temperatures are combated with sponge baths and partial or complete packs with tepid water, and with antipyrine or antifebrine. Quinine is not used as an antipyretic. A pack is often continued for several hours, the patient having little or no clothing but the wet sheet. It is not regarded as necessary to resort to any of the water measures till the temperature has reached 103° F., and rarely then unless they are grateful to the patient; and they are discontinued as soon as the temperature falls to 101° F. During the bathing and packing, as well as at all other times, the extremities of the patient are kept warın by clothing and hot applications, regardless of the temperature of the trunk of the body. A bath in a tub has not been used.

Antipyrine is given in ten to twenty- grain doses at intervals of one or two hours when the temperature is high, and the pulse not specially weak. More than three such doses are rarely received by a patient in a day, or a night. Patients who have, with their high temperatures, fulness and pain in the head, experience most relief from this remedy and to such it is given by preference.

A high temperature for a few hours each day is not regarded as, per se, a very grave condition; and the disposition on the part of internes to use antipyretics of all sorts, is repressed rather than encouraged.

In the Presbyterian Hospital, of Chicago, a thorough cleansing of the patient is first secured, by means of a full bath externally and calomel internally. In cases of diarrhoea mercury and chalk are substituted for calomel. In doubtful cases, where the possibility of malarial fever is admitted, full doses of quinine are prescribed for a few days, but they are discontinued as soon as the uncomplicated typhoid character is apparent. During the course of the fever, when no complications arise to require special attention, the patient is frequently sponged with tepid water. The kidneys are stimulated with a solution of potassium chlorate-one drachm to the pint of water, the whole to be drank during twentyfour hours. If patients prefer an acid draught, they are allowed lemonade, tamarind water, or dilute phosphoric acid and water, so long as diarrhoea does not forbid. Sleep at night is procured for restless patients by the administration of whisky and milk, or urethan in halfdrachm doses, or chloral hydrate with potassium bromide. Opiates are rarely found neces