SNAKE BITES.-Give 5 grains of bicarbonate of ammonia every five minutes; administer an enema of mustard and water, with two drachms of tinct. of valerian, which may be repeated if returned. Apply a mustard cataplasm over the cardiac region, and then give the following: Chloroform 7j; spirit 3ij; mist. camph. Ziij. M. ft. m. 3j every ten minutes. (Dr. Lowndes, Monthly Journal, Feb. 1854, p. 186.) PRACTICAL MEDICINE, &c. DISEASES AFFECTING THE SYSTEM GENERALLY. ART. 1.-ON FEVER. By DR. WILLIAM STOKES, Regius Professor of Physic in the [The peculiarities of fever, as a disease, are of a negative kind: it is a disease which has no known or constant anatomical character, because even in the most marked cases of the disease, the patient may die, and yet the most skilful pathologist can detect no lesion or anatomical change in any of the structures of the body to explain the cause. Dr. Stokes remarks] I believe that we may go thus far and say, that when the fatal diseases of the world are considered, the malady which destroys most men is a disease in which there is no anatomical character. You all naturally ask, "If this be so, how did the French school come to commit the extraordinary error of declaring, that in every case of fever there was an anatomical character?" The reason is simply this, that they committed a great error in medical philosophy,—that of inferring the nature of a disease from the observation of its phenomena in one locality. Had Broussais and his followers studied fever in the wards of the Dublin hospitals, or had they gone abroad and examined fever in the West or the East Indies, or on the coast of Africa, we should have heard nothing of the doctrine that fever was symptomatic of this or of that local disease. We find, moreover, that fever is a disease of periodicity, that it runs a certain period, varying in different epidemics and different individual cases. We find, further, that it is a disease in which a double danger affects the patient. One of these dangers is, that of death from simple depression; for so far from fever being a disease of plus vitality, it is a disease of minus vitality-a general condition, if we may so speak, of minus vitality, which of itself is often quite sufficient to destroy life, and the patient may die, and very often does die of debility alone. The poison of fever has thus a directly depressing influence on the system. But there is another condition, and this is what I wish to draw your attention to very strongly,-that, in the course of that special mode of life which we call fever, a liability exists to the production of secondary diseases. You will get a good general notion of this by considering the ordinary phenomena of a case of small-pox. The patient is taken ill; he has shivering, pain, fever, and he remains in this state for several days. And then we observe vesicles appearing on the surface, those vesicles filling with pus, afterwards drying, and then disappearing. No man will say, that the fever was symptomatic of the eruption. It is exactly the reverse; the eruption is the result of the fever. So it is in typhus. The local diseases are generated by the general. There is this difference, however, between what we term continued fever and the exanthemata: that while in the latter the local disease is almost always, but not necessarily always, accompanied by certain characters, as, for example, in variola there is a certain kind of eruption, in scarlatina-in measles a certain condition of the skin,-it is not so with respect to the secondary diseases of typhus. Now this is a most remarkable circumstance connected with continued fever, that the secondary diseases are inconstant. They are doubly inconstant, in their seat, and in their amount; and, in the same epidemic, we see the greatest possible varieties in the seat and in the amount of those secondary affections. However, between the exanthemata and typhus fever there is this point of resemblance, that the secondary affection is utterly incompetent to explain the general phenomena of the disease. So that we may say, with regard to the secondary affections in typhus fever, that they are inconstant and incompetent to explain the disease. But they are of very great importance. It may be asked, what are those secondary diseases? are they inflammation? The present condition of medical science furnishes this answer;-they are not inflammation in a vast number of cases, when you consider them in their early stage, but in many instances, after they have existed in this non-inflammatory state for a certain time, there comes on a re-active irritation, and we have then a mixed condition. This is the history of the ulcerations of the intestine. In the beginning we find tumefaction and infiltration, but without any appearance whatsoever of inflammation. It has been proved, that in a vast number of cases the disease goes no further, and there is retrocession of the swelling and of the infiltration, just as we see retrocession of the eruption of small-pox; but, in others, the parts into which this typhoid matter has been infiltrated take on a reactive inflammation, and then we have a combination of the essential disease and of the local disease, which is now inflammatory, though it was not so at first. We shall have abundant opportunities of proving this. The treatment of fever is reducible to a simple formula. We cannot cure fever; no man has ever cured fever. Fever in this sense may be called incurable, because we don't know how to cure it. It is, however, curable by itself. If you leave it to its own course, it will often cure itself. The great object, then, is to preserve the patient's life from the dangers which threaten him, pending the existence of this condition of fever-of this special state of life. If you can keep him alive to the fourteenth day, or the eighteenth day, or the twenty-first day, he will recover. What are the dangers that occur in these cases? One I have already pointed out to you-it is the danger of debility; the other is the danger arising from the accidental secondary affections. We cure the patient by preventing him from dying. We lead him on to that period when, by the extraordinary law of the disease, it will itself spontaneously terminate. We prevent him from dying of exhaustion, by food, by the use of stimulants, and by tonics. We save him from the danger which the local diseases may expose him to, by meeting them as early as we can discover them. And herein lies the whole secret of the treatment of fever-to preserve the patient, at the least expense to his constitution, up to the time when, by the natural law, the disease will spontaneously subside.-Med. Times and Gazette, Jan. 21, 1854, p. 55. [Dr. Stokes observed that since the period when he gave a systematic course on the subject of fever, his views on that disease had altered. He says:] Although we formerly held that the local alterations were secondary to the fever-that they were really symptomatic of the fever, not the fever symptomatic of them, as Broussais taught-yet we did not sufficiently recognise the fact, that in most cases the inflammatory action associated with them was itself secondary to the local lesion that it was re-active, and, as such, had probably less pathological value than the local change which preceded it. Again, the opinions which were then inculcated as to the influence which the local diseases had in causing a fatal result must be in at least two respects modified. I formerly was of opinion that death in fever was mainly to be attributed to the virulence or number of the local diseases. Such is not my opinion now; for, although in examining the bodies of many patients who have died by fever, we find various local alterations, yet they are often insufficient to account for death. And we have had abundant proofs that the typhus state itself may cause death, without there being any manifest local disease in any part of the system. In another, and seemingly opposite point of view, our opinions have changed. For I think, that so far at least as the lungs are concerned, we did not sufficiently estimate the danger produced by the local disease independent even of the re-active inflammation. To this point I shall hereafter draw your attention more fully. We too exclusively considered the local affections as inflammations, though secondary to the fever; and did not sufficiently admit them as special typhous lesions or deposits, which might occur without any inflammatory action, or precede it. To sum up, then; whatever be the changes that may have occurred in my opinions about fever, they are rather developments of the doctrine formerly taught than its rejection, or the substitution of any essentially opposite view. In all points relating to the essentiality of fever, the influence which the law of periodicity exerts upon its phenomena, the secondary nature of its local affections, and, lastly, its contagious character, my views remain unchanged. But on those points to which I have already alluded, the alteration of our views is important as bearing on practice, inasmuch as it points more decidedly to the adoption of a treatment directed to the general more than the particular or local condition, and again to the more liberal employment of the tonic and stimulating treatment in the typhus of this country. You will easily anticipate the general result of the views which I now attempt to teach you. They have led us to attach less importance than we did formerly to the inflammatory state in fever; that is, to the condition that indicates an antiphlogistic treatment in the ordinary sense of the word. In the use of stimulants we have become much more bold, even under a great variety of circumstances. But I must say, that with reference to the employment of wine in large quantities, we have been drawn to this mode of treatment less from any theory than from simple and accumulating experience, by which we became less and less timid in the use of stimulants. Observe here, how a truth in pathological anatomy may be foreshadowed or anticipated by observing the effect of a therapeutic agent. [Diseases may be divided into three great classes. 1st, diseases having an anatomical character. 2nd, diseases having no anatomical character, but which are not fevers-these we class neuroses-such as mania, epilepsy, hysteria, chorea, &c. The 3rd class is fevers. We may ask, then, how do fevers differ from neuroses?] Fever seems to be a special condition of life which is to exist for a certain time, and then to cease, that is to say, it is under the law of periodicity; and, in this respect, the phenomena of fevers differ very much from those of the pure neuroses. There are other differences, too, between fevers and neuroses. It is quite true, that in a large number of fevers, death may take place without any organic change that we can demonstrate anatomically; but it is true, on the other hand, that, in a large number of cases, there is a tendency to the development of what I designate the secondary lesions of the disease. Thus, if we compare these two classes, the neuroses which are not fevers, and the fevers properly so called, we find this great difference, that among the former, as for example in hydrophobia, we do not see any tendency to the development of ulcers of the intestine; nor in epilepsy do we find any tendency to the development of bronchial diseases, nor in mania do we see a cutaneous eruption; nor in convulsions do we find any of these various organic changes produced. This tendency, then, to generate or produce local anatomical changes secondary to the fever is another remarkable distinction between this |