or zymotic conditions. I do not hesitate to decide this question affirmatively. It does not come within the sphere of this article to seek for the reasons thereof; still, no one of experience free from prejudice will assume the contrary. The appearance and course of measles, of scarlatina, and of diphtheria bear the impress of a fermentation, which under certain circumstances is capable of assuming a decidedly putrid character akin to the surgical septicohæmia. How the poisoning ferments are constructed, whether they represent true fungi and fungous germs, is only of secondary importance in connection with quinia.* We have only to maintain that no gas, but solid molecules are the agents of infection, and that these again can only be derived from, or are actual particles of, cells.† Until now, however, no fermentation of organic matter through cells (yeast, vibriones), or through cell-particles (emulsin, myrosin), has been examined under the influence of quinine without its resulting in the fermentation being at least enfeebled by it. Analogy therefore calls upon us to administer quinine as an antizymotic in those diseases when they manifest a tendency to assume a threatening character. True, conclusions by analogy are generally only to be set up with the utmost caution, and I will willingly retract my proposition, if any one knows anything more reliable by which to * This seems to be true, in every particular, of diphtheria, for Letzerich according to Hüter, has now proven that the commencement of this disease is a putrid state of the tissues through the formation of a low grade of fungi (Virchow's Archiv, vol. 45, p. 327; vol. 46, p. 229; vol. 47, p. 516). + Virchow's Archiv, vol. 46, p. 162. fulfil the indication to counteract the morbid tendency; but nothing else of the kind is known, and it therefore seems to me to be the duty of the physician to employ internally a remedy which, at any rate, cannot readily do harm, in all cases where there is danger or apprehension that measles, scarlet fever, diphtheria, or the like will assume a dangerous course. Three conditions will have to be kept in view in using quinine as above, although the possibly negative results should happen to be perfectly evident. First, the doses should not be too small; secondly, a readily digested preparation should be selected; and, thirdly, the drug should be administered before the disease has obtained its acme. Concerning the first and second points I have already expressed myself more fully on a former occasion.* The opinions met with here and there in the scattered literature of the day would lead one to believe that the old method of administration was sustained with more energy than justice. No attention is given to the fact that fractional doses of quinine are almost as useless for the infantile organism as for that of the adult; or that larger doses of the almost insoluble sulphate of quinia have but little chance of being absorbed in the stomach of a feverish patient that is coated with mucus and deficient in acid. At any rate, the preparation should only be given when dissolved in muriatic acid, unless we are rather desirous of employing the alkaloid combined with that acid. Experimentelle Untersuchungen über das Wesen der Chininwirkung. Berlin, 1868, p. 58. As regards the third point, I have recently instituted experiments concerning the antipyretic action of quinine in the very great increase of temperature following a destruction of the cervical portion of the cord.* Among other things it is then seen that a very brilliant effect is produced by it, so long as temperature is not increased too rapidly, or if it has not as yet attained a very high degree; that, on the contrary, in animals used for experiments (dogs, etc.), even the largest doses, viz., three to four grammes, are almost wholly ineffectual, if the condition alluded to has already taken place. I may indeed assume that these experimental results point to the method of employing quinine in acute fevers, especially where, as for instance in scarlatina, the temperature of the body is increased to so high and dangerous a degree. The remedy should be given from the very commencement in sufficiently large doses, the progress of the disease carefully watched by the aid of the thermometer, and the doses increased in quantity if the fever grows threatening. Few but large doses, according to Liebermeister,† are to be given at every nor mal remission of the fever, and in addition other refrige rant measures, especially the methodical reduction of the temperature by cold water, are to be instituted. Only when these means have been tried as described here, and no marked effect is obtained, is one justified in asserting that quinine is of no avail in this or that disease. Even Therapeutics calls for logical methods, * Naunyn and Quincke in Reichert's Archiv, 1869, p. 174. and all negations not wholly logical are just as untenable as the positive assertion of an unproved fact. Of the acute exanthema of infants, I would mention one particularly as being within the sphere of the influence of quinia, namely, erysipelas neonatorum. This disease, as is well known, belongs to a class which almost invariably terminates fatally. As a general rule, an internal dyscrasia or an external putrid ulceration of the navel is assumed as its cause. A German naturalist of renown* related the following case to me last year at an accidental meeting, which I am obliged to recount from memory, not having made any memoranda of it at the time. For the accuracy of the main points I am responsible. A male infant of his own was attacked by violent erysipelas soon after birth. The physician who was called in by him, a well-known German gynecologist, prescribed the usual remedies, but pronounced the case a hopeless one. The father, who is versed in medicine, now began to treat the child upon his own responsi bility, and having a very high opinion of the curative powers of quinia against collapse, from which the child also suffered to a great degree, he administered the sulphate in comparatively large doses. The erysipelas improved in a remarkable manner, all danger soon vanished, and the boy recovered completely. Subsequently coxitis developed itself and ran its usual course. * Should any physician desire more detailed information, it will be furnished him by addressing me. From the standpoint of our present knowledge, there can no longer be any question but that quinine is capable of exerting a direct tonic influence upon the nervous system. Even Bricquet,* in his excellent monograph, which for his times was very thorough, speaks always of the "hyposthenizing" effect of quinine on the various parts of the human system, and this he demonstrates by numerous experiments; and I also have often perceived the exhilarating effect produced upon the system of a healthy animal by the exhibition of eight-grain doses. But up to the present day everything that has been said of the mysterious relation of quinia to the sympathetic has remained without a shadow of proof; one portion of it, in fact, has already been completely controverted.+ Thus, then, in the case just related and in numerous others, some of which I have described on a former occasion, we have to attribute the action of quinine to other factors, I mean: to the overcoming of the alteration of the blood lying at the bottom of erysipelas neonatorum, to the diminution of the high temperature, and to the direct removal of the histological causes producing the erysipelas.§ Both theory and practice command us no longer to regard the disease alluded to as absolutely fatal, nor quinine in its use as an accidental * Traité thérapeutique du Quinquina. Paris. 2me ed. 1855. + Lewitzky in Virchow's Archiv, Bd. 47, p. 352. Pharmakologische Studien über Chinin. Virchow's Archiv, Bd. 46, pp. 67 und 129. § Volkmann and Steudner, in Centralblatt f. d. Med. Wissensch. 1868, p. 561. |