396 



SCIENCE. 



[Vol. VI., No. 143' 



antipyrin are the only ones in general use. 

 Antipyretics may act either by reducing the pro- 

 duction of heat, i. e., the oxidation process ; or by 

 increasing the amount of heat given out from the 

 body; or by paralysing certain micro-organisms 

 whose action irritates the heat producing mechan- 

 ism ; or by restraining and regulating the action of 

 these heat producing nervous mechanisms directly. 

 It is to the latter theory that Filehne and Lieber- 

 meister assent. The latter, to whom is due the 

 use of cold baths in the treatment of fever, ad- 

 mitted that antipyrin was applicable in some 

 cases where the application of cold was unad vis- 

 able. But cold baths are not to be given up. A 

 healthy man in a cold bath (68° F.) gives off in 

 ten minutes seven times as much heat as under 

 ordinary circumstances. But his body tempera- 

 ture remains the same. Therefore the effect of 

 the bath is to increase seven times the production 

 of heat in the body. If the bath is long continued 

 the temparature falls shghtly. After the bath the 

 temperature falls slightly. The same is true in 

 fever with this difference, that the fall of tem- 

 perature foUows a cold bath more quickly, and to 

 a much greater degree than in health. In many 

 cases this removal of heat by bath is indispensable, 

 even though it is accompanied by an increase in 

 the production of heat, for in fever experience 

 shows that the amount abstracted exceeds the 

 amount produced. According to v. Jaksch, thallin 

 in 0.25 dose produces a fall of temperature more 

 quickly than antipyrin in 1. dose. It is apt, how- 

 ever, to produce a chill and sweat, and its effect is 

 not so lasting as that of antipyrin. Neither of 

 them affects the duration of a specific fever (such 

 as pneumonia or erysipelas), or relieve the distress 

 *of the patient. In pneumonia and erysipelas their 

 use prolongs the jieriod of convalescence by reduc- 

 ing the recuperative powers of the patient. They 

 are, therefore, to be used only in cases of fever in 

 which the temperature rises to a dangerous point, 

 or in which cold batliing cannot be used. To this 

 opinion Striimpell of Leipzig agreed. Others 

 maintained that the reduction of temperature 

 gave the patient much comfort, relieving many 

 distressing symptoms. All agreed that the use of 

 cold baths, or cold sponging, was preferable to the 

 use of drugs. 



Asthma was the subject of a long and exhaust- 

 ive discussion, which ehcited a number of sub- 

 divisions of the affection of some therapeutic 

 importance. Asthma is regarded as a nervous 

 affection, attended by a sudden obstruction to ex- 

 piration, with dilatation of the lung. It may be 

 a primary disease due to changes in the nervous 

 centres governing respiration. In the majority of 

 cases, however, it is a secondary disease of reflex 



origin. An irritation arising at some point sets 

 up an excitement of the nervous mechanism of 

 respiration, which shows itself by the attack. 

 Such an irritation may come from the mucous 

 membrane of the nose when that is thickened by 

 chronic catarrh, or covered with polypi, or 

 irritated by some external material, as in hay 

 fever, in which case operative measures on the 

 nasal cavity, or anaesthetics applied to it, will cure 

 the asthmatic attacks. Or the irritation may come 

 from the finer bronchi, and the inflammation of 

 these may set up a spasm, and thus cause the 

 attack, in which case the treatment must be 

 directed toward the bronchitis. The exact charac- 

 ter of the spasm attending the attack is unde- 

 termined. Some regard it as a spasm of the dia- 

 phragm, which prevents this muscle from relaxing, 

 as it normally does, in expiration. This view is 

 based upon the fact that electrical excitement of 

 the nerves to the diaphragm will produce results 

 similar to those occurring in asthma, while ex- 

 citement of the nerves to the bronchial muscles 

 does not produce asthma. The majority of 

 authorities, however, consider this theory ques- 

 tionable, and hold that a true spasm of the mus- 

 cular coat of the finer bronchi causes the attack. 

 All admit that the spasm, from whatever cause, is 

 best combated by narcotics, of which morphine 

 and chloral are the most reliable. But treatment 

 of the attack should always be followed by treat- 

 ment of the cause, especially if that is easily 

 reached, as in cases of nasal catarrh. 



Acute articular rheumatism has lately been re- 

 garded as an acute infectious disease like pneu- 

 monia and typhoid fever. The opinion was ad- 

 vanced by Edlef sen that it developed in certain 

 localities in Kiel more frequently than in others, 

 and he found, in investigating 845 cases, that per- 

 sons living in certain houses were especially liable 

 to the disease. He concluded that the micro- 

 organism causing the disease is one which 

 cUngs to dwellings, especially such as are built 

 on damp ground, and advises persons who are sub- 

 ject to frequent attacks to change their residence. 

 Such authorities as Jurgensen and Friedlander 

 agreed to this view, and in support of it cited the 

 fact that in certain barracks and hospitals, cases of 

 acute rheumatism developed in great numbers. 

 All admitted that the mortality had diminished 

 greatly since the use of salicylate of soda was 

 introduced. 



A number of shorter papers of value were read, 

 which are not of such general interest as to de- 

 mand notice. The proceedings of this congress 

 should be followed by all physicians interested in 

 the progress of scientific medicine. 



M. A. S. 



