INTERMITTENT FEVER. 671 



favorably, the false membranes being detached and the fever sub- 

 siding in a few days. Such cases are common in youths and adults, 

 but advance of the disease to the larynx is more to be dreaded in 

 infants. As the first deposits clear off, others may take their place. 



In septic or putrid diphtheria there is infiltration and mortifica- 

 tion of the mucous membrane itself, with consequent ulcers and 

 gangrenous loss of tissue. The detached fragments putrefy and 

 give a foul odor to the breath ; the submaxillary and lymphatic 

 glands are swollen ; there is fever characteristic of septicaemia ; and 

 usually the patient dies in a few days. But a line of demarcation 

 may form around the necrosed parts, and recovery take place. If the 

 disease attacks the nose, it causes a running, which may be mistaken 

 for cold in the head till the discharge becomes bloody or sanious. 



Diphtheritic paralysis may not occur till four or five weeks after 

 the disease ; it is peripheral in character, as is shown by the diminu- 

 tion of electro-muscular excitability ; it lasts several weeks or even 

 months ; it most frequently affects the muscles of the pharynx and 

 eye ; the prognosis is usually favorable. 



In the treatment, various disinfectants, such as chlorine one part 

 to six of water, weak solutions of carbolic acid, salicylic acid, per- 

 manganate of potash, also alcohol, etc., may be employed locally in 

 conjunction with hot vapors, which hasten suppuration, and possibly 

 the pus may wash off the micrococci ; these hot vapors may be tried 

 every half hour or so. We should avoid rough or frequent cauter- 

 izations, for fear of increasing the inflammation. In diphtheria of 

 the larynx we may use sprays of lime-water and salicylic acid. 

 Tracheotomy has rarely proved a successful operation in this dis- 

 ease. Internal administration of chlorate of potash and tincture of 

 muriate of iron, properly diluted, and in doses suited to the age, 

 every half hour to two hours, is perhaps one of the most favorite 

 methods of treatment.] 



MALARIAL FEVERS. 

 CHAPTER XI. 



INTERMITTENT FEVEK. 



ETIOLOGY. Intermittent fever results from infection of the body 

 with a poisonous substance called marsh miasm, or malaria. Malaria 

 is not a product of decomposition (see below), but the decomposition 

 of vegetable substance has an unmistakable influence on the devel- 

 opment or excessive increase of this poison. I shall only adduce the 

 following circumstances in support of this fact : Malarial fevers are 



