which in these communications is so strongly asserted. Many of the higher institutions of learning (both literary and professional, both in this country and in Europe) are free* to all who choose to make use of their advantages. This is notably the case in the great medical colleges of Continental Europe, where students pay nothing for tickets, and the salaries of the professors are merely nominal-so small in many cases they are not drawn at all. Yet it has not come to the knowledge of the committee that it was ever held by anybody that there was anything in all this derogatory either to the students or to the teachers or to the profession.

It seems, furthermore, to the committee that the question of college fees, and indeed of the whole internal management of medical colleges, is one over which the medical profession at large have no jurisdiction; and that the sooner this fact is recognized the better it will be for all concerned. In this direction the experience of twenty years proves conclusively that nothing can be accomplished towards that professional reformation of which so much is to be heard.

The failure is not to be wondered at. Success has not been sought through the proper channels. Let the profession do its duty wisely and bravely-not by railing at the colleges, but by attending honestly and earnestly to its own legitimate business, and we may hope for more satisfactory results. The profession has the right, and indeed it is their bounden duty, in conscience and right reason, to regulate the qualifications of those whom they admit to professional fellowship. Let them do this with clean hearts and strong hands, and they will have little need to trouble themselves about the fees of colleges. If they cannot do this, if with all the strength of their thousands of members they cannot or will not thus work out their own salvation with fear and trembling, the smallest spark of magnanimous feeling ought to be enough to keep them from seeking

*This is a serious error.

E. S. G.

to impose the burthen upon the shoulders of a few College Faculties.

The committee cannot see how the inauguration of a free system of medical instruction can prove so disastrous to the cause of medical learning as is assumed in the communications under review, and assumed, too, without any attempt to sustain the assumption by any sort of testimony. It would seem, on the contrary, according to the ordinary course of things, that every device which removes another obstacle from the pathway of the medical student ought to facilitate his progress in medical knowledge.

However this may be, the committee feel assured that no considerations inconsistent with either personal or professional honor have moved the Faculty of the College to the step which they have taken. Of this their past record is a sufficient guarantee. They have always been foremost in every attempt to advance the profession to greater dignity and wider usefulness; and in this connection it ought never to be forgotten that it was from this Faculty (through one of its members) that the proposition was made before the Medical Association of the State of Alabama, where it is now pending, to establish such a system of censorship as will effectually keep incompetent men out of the profession; a proposition which is all the more remarkable because it neutralizes the privilege so dear to all medical colleges of conferring diplomas which carry with them the right to practice medicine and collect fees.

In conclusion, then, the committee can see no reason why the abrogation of fees for lectures in the Medical College of Alabama should furnish occasion to the profession of the State for the grave apprehension expressed by the Societies of Merriwether* ad Montgomery; can see no reason why, for this cause, the prosperity of the college should be threatened with ruin or its honorable repu.. tion suffer abatement; can see no reason,

* The editor of this journal will be pleased to the transactions of the Merriwether Medical Society.

therefore, why for this cause the protest of the societies mentioned should receive the approval of the Mobile Medical Society.

All of which is respectfully submitted.

JEROME COCHRAN, M. D.,

The foregoing report was made to the Mobile Medical Society at the meeting held on the 19th of December, 1870, by the committee appointed for that purpose; and was adopted by unanimous vote at the meeting held on the 7th January, 1871; when it was also ordered to be printed and communicated to the medical societies of the State.

E. D. GAINES, M. D., President.

E. H. FOURNIER, M. D., Secretary.

ORIGINAL CORRESPONDENCE,

"Sit mihi Fas scribere audita."

MONTGOMERY, ALA., January 19, 1971.

Mr. Editor,-Notwithstanding the fact that a great many articles upon the subject of hæmorrhagic malarial fever have been published in the New Orleans Journal of Medicine, I notice that few have appeared in your journal, which, being a monthly, is probably more widely circulated in the South and West than any other medical journal. And as it is of the utmost importance for the profession to become familiar with all forms of disease with which they are likely to come in contact, Ive concluded to send you a short paper upon the abovemention disease.

I shall acknowledge my indebtedness at the commencement to Drs. Michel, Osborn, Riggs, Ghent, and others, who have written so well upon this (to us of the South) most terrible dis

ease.

To Michel and Osborn I will refer those who wish a full history of this form of malarial fever. Dr. Michel's most valuable paper can be found in the Transactions of the Alabama State Medical Association for 1869, and in the July number of the New Orleans Medical Journal for 1869..

My object is to familiarize the profession with a most formidable disease, and one which may be encountered at any time by any one living in a malarial country. A malady that assumed such a strange and appalling livery when it first made its appearance in this portion of the country as to strike terror not only to the hearts of the people, but made the intelligent physician quail as he felt the responsibility of being brought in contact with a most fearful enemy, and feeling most uncertain as to how he should grapple with it.

Now, if this short article shall perchance be of any benefit to any physician who is yet to encounter the disease for the first time, I shall be paid in full for any trouble that this selfimposed task may have occasioned me.

The cause of this disease is, beyond a doubt, malaria acting for a long time upon the system. The great majority of cases having been sufferers from repeated attacks of intermittent or remittent fevers-occasionally, however, we hear of its sudden onset; but this is very rare indeed, and never, to my knowledge, when the person was in perfect health for some time previous to the attack.

I shall not dwell in speculations as to how this poison acts the system, so as to produce this form of fever-my object being entirely practical.

upon

The first symptom is a cold sensation, as experienced in an ordinary chill. Frequently, however, coming on at night, which is different from the usual commencement of an attack of malarial fever.

This cold stage returns regularly in some cases every six, eight, or twelve hours, and is followed always by a corresponding reaction.

Nausea and vomiting usually commences with the first cold stage, and continues to be the most distressing symptom throughout the attack.

The first thing, however, which attracts the attention of the patient and friends, is the appearance of the urine, which is noticed to be bloody the first time it is voided after the commencement of the attack. An ordinary chamber-pot is frequently halffilled at one time; and sometimes enormous quantities are passed in the first twenty-four hours. Little smell or other characteristics of urine are observed.

It is this symptom which has given rise to the name of "hæmorrhagic malarial fever," first proposed by Dr. Michel, of this city, and endorsed by the Medical Association of the State. Other names have been proposed, but as this symptom is always present, in well marked cases, it seems to be appropriate.

In mild cases, where there is a complete intermission, this bloody urine intermits also, returning with each exacerbation. Where there is little remission (for this cold sensation spoken of above frequently comes on without any premonition, and whilst the fever seems to be in full play) it rarely lasts longer than forty-eight or seventy-two hours, and then ceases, whether you give remedies directed to this particular symptom or not.

I wish to call particular attention to this, as I am inclined to think much damage is frequently done the patient by administering medicines that have no other effect than to irritate an already exceedingly irritable stomach.

In fact this

The next most distressing symptom is nausea. is the most terrible feature of the disease, frequently precluding all idea of medication or nourishment through the stomach.

The matters vomited are at first yellow; presenting to the naked eye the appearance of black vomit, as we see in yellow fever; but never yielding the characteristic tests of true black vomit.