ties of quinine. In this I shall cite a few cases and base my remarks upon them with the sole design of illustrating the views which I entertain. I am convinced, that much temporary inconvenience if not injury is often caused to patients, laboring under autumnal fevers and other febrile affections, by an injudicious administration of quinine; and that this injudicious administration proceeds from a mistaken idea of its precise medical properties: especially from the belief that it is purely tonic or stimulant. Neither of these properties pertains to the sulphate of quinine, unless it be indirectly, by reducing the febrile action and diathesis. In febrile affections attended with an irritable condition of the nervous system, and exhausted vigour of animal action, quinine will be decidedly prejudicial. In these cases it increases the nervous irritability, impairs cerebral energy, and produces great precordial distress. I know several persons of nervous temperament who suffer so much from a single dose of quinine, that no persuasion would induce them to repeat it: one gentleman in particular is thrown into a perfect delirium by a full dose of quinine, even in the state of fever, and much more so in the absence of fever. Two cases came under my observation last summer in which death was caused in a few hours by only two doses of quinine. The patients were two black children, one five, and the other six months old. They were taken with a catarrhal bilious fever about the 10th of September, when it prevailed epidemically in this vicinity among the infants and children. These two infants had been sick four or five days, had taken eight or ten small doses of calomel, which had excited and kept up copious yellow and green mucous discharges from the bowels; and the general nervous and cerebral irritation was augmented, and the febrile action reduced to the irritable kind. At this stage I saw them; pre

scribed mild demulcents, gentle anodynes, fomentations to the abdomen, and gentle saline laxatives after the irritable condition of the bowels was allayed. On the third day after I saw them, they were clear of fever and apparently in a fine condition for convalescence. In this condition, with a view of preventing fever, each of them took one grain of quinine and half a grain of Dover's powder at 2 o'clock, and repeated it at 5 o'clock. Soon after the first dose, the fever appeared to rise, the pulse became active and throbbing; the head hot, and pulsating, with general uneasiness. All these symptoms increased soon after the second dose; and became greatly aggravated about 7 o'clock, attended with partial spasms. One died at 9 o'clock, and the other in half an hour afterwards.

Remarks. At the time the first dose of quinine was given, these children were in a fine state for convalescence without any medicine, and would in all probability have rapidly recovered under the occasional exhibition of a very small portion of weak brandy toddy, with a few drops of paregoric, or essence of peppermint in it; and with an occasional mild laxative. The quinine in very small quantities, one-eighth to one-fourth of a grain, might have been beneficial: but the condition of the little patients was not such as to bear a full dose. Adults in our country are sometimes, during convalescence from bilious fevers, in precisely analogous circumstances, espe cially females; and in them quinine administered in the same proportion would be almost as detrimental. But in them a consciousness of its pernicious effects would cause them to refuse its further administration. In such cases, if the tone of the system were not impaired, and if the nervous temperament did not predominate, the use of quinine combined with some aromatic would be applicable: but otherwise the infu

sion of cinchona and ginger, or weak toddy is decidedly preferable.

The above is evidently the experience of M. Vulpes, of Naples, when he describes the sulphate of quinine as "more irritating than the cinchona." Yet Dr. Eberle, (Practice, vol. 1, p. 73,) in commenting upon the experience of M. Vulpes, says, he has never perceived such difference in the action of the two articles. Yet Dr. Eberle (Ibid, p. 76,) admits that he has seen pernicious effects from large doses in the cold. stage of intermittents; and, that he suspects that certain cerebral irritations in a lady of delicate constitution, and in a lad, were attributable to its improper use. These effects I am confident will not be produced in the robust and the athletic, whether they have fever or not. Dr. Eberle however thinks quinine a good substitute for barks, and much more convenient when bark is rejected by the stomach. On this point I remark, that quinine will disagree with the nervous system as often as the bark does with the stomach; but the cases in which quinine generally disagrees, are those of persons of nervous temperament, and irritable condition of the nervous sys

tem.

Very little testimony of any kind in relation to quinine is to be obtained from Dr. Eberle's Practice of Medicine; and it is somewhat surprising that he does not recommend quinine as a remedy in fevers, either continued, remittent, typhus, or bilious. He recommends it principally in intermittents, and even in those cases, he appears to be without any definite views as to its specific action, other than as a tonic or substitute for bark. Throughout the whole work he confounds the two articles, cinchona and sulphate of quinine, as possessing the same properties, and applicable in the same cases. There is no man whose authority in medicine I respect

more than that of Dr. Eberle, in matters pertaining to therapeutic practice: but in regard to the use of quinine I am satisfied he has not made such use of it as would enable him to speak of it in clear and definite terms.

To illustrate my views of the pernicious effects of quinine in persons of delicate constitution, nervous temperament, and debilitated condition, I will give the following case, which came under my observation in the spring of 1837.

CASE.-Mrs. L. F.æt. 28 or 30 years, of temperament lymphatic and nervous, strongly marked. During the latter months of gestation with her third child, she became greatly afflicted with deranged functions in all the organs of assimilation; such as were indicated by pyrosis, cardialgia, anorexia, and even bulimia, alternately, and an inability to retain anything on her stomach. These symptoms became so aggravated towards the termination of gestation, that for six weeks previ ous to her accouchement, she was confined to her bed and room. Various antacids, carminatives and such like remedies were used without relief; venesection was used freely several times, and, to say the least of it, without benefit. She became weak, pale, and emaciated, although with a kind of ædematous fulness of features. In this state the pulse became weak, quick, and irritable; the brain became irritable and very sensible to the slightest degree of light and sound. In this state she was delivered of a fine healthy son. She passed through the stage of labor without any untoward circumstance, but her condition became daily more precarious and distressing. I first saw her on the eighth day after her accouchement, in the following condition: viz.-The lochiæ were profuse and watery; there was a profuse secretion and frequent discharge of thin yellow bile; the pulse weak, quick and irritable; the stomach frequently rejected all ingesta;

the senses of sight and hearing were so acutely sensitive that the room was kept perfectly dark, and the lightest walking in the stocking feet over a carpeted floor gave her great pain, as did also the most moderate whispers in the opposite side of a large room. During the last eight days she had been under the constant attendance of two physicians, and had used freely of magnesia, blue mass, calomel to free ptylism, besides bloodletting twice before the mercurials. Sulphate of quinine was also alternated, with occasionally a small portion of morphia. Nevertheless, all the distressing symptoms had become daily more alarming; and when I first saw her she was unable to raise her head from the pillow; the tongue and face as pale as marble. The last medicines which she had taken were small doses of quinine and blue pill, to the exclusion of the small portions of morphia which she had been taking previously..

In this state I advised the discontinuance of the blue pill and quinine, and to substitute aromatic stimulants and morphia in small quantities; but to satisfy the physician in previous attendance I consented to continue the quinine in doses of 1 gr. every six hours, besides other remedies. Having remained three days and nights without intermission, I had the best opportunities for observing the effects of every article given. About one hour after each portion of the quinine was taken, although in so small a quantity, the nervous irritation became aggravated. The portion of quinine was occasionally omitted to see whether the accompanying change would take place; but the aggravated state of nervous sensibility and irritation did not occur without the quinine, and it was finally dispensed with entirely. Having, in cases somewhat similar, obtained good effects from the oxide of bismuth, I determined to give it a trial in this case. I accordingly gave a powder