certain whether the investigations of Schlockow and Eulenberg, relative to the controlling of reflex excitation by quinine, are of any value.* Unfortunately, they refer only to experiments on the frog, and to doses which, if calculated according to the weight of the body, are perfectly enormous. But the nervous system of the frog is very differently affected by nervous poisons from that of man, as may be readily seen by the use of morphine. Hence, so long as no experiments have been instituted on rabbits and dogs at least, that would go to show that in these too the normal and pathological reflex excitability can be reduced by moderate quantities of quinine, we have no sure guide for the test proposed. There are as yet no experiments which prove that quinine in higher animals possesses any specific nervine effect. I am not prepared to deny that possibility; but the principle should always be adhered to, that therapeutic experiments and conclusions can only claim what has been indisputably proven. It seems to be always possible to prove that quinine acts independ ently of the nervous system. Thus Lewitzky has shown that the action of the drug on the heart is totally independent of the pneumogastric and sympathetic nerves; and I also have found by recent investigations, which will be published at a future time, that the refrigerant action of quinia may take place wholly independently of the central nervous systems. As regards the symptomatic employment of quinine *Reichert's and Dubois' Archiv, 1865, p. 423. + Op. cit., p. 360. in infancy as an antipyretic, I agree with Jacobi's statements at Innsbruck.* "Quinine," he says, " reduces the temperature more markedly and quicker than any other remedy, and does not act so rapidly on the pulse; unpleasant effects, such as vomiting, do not occur from Hence it is to be given in all diseases where it is necessary to foster the powers of the system, as in zymotic affections, chronic inflammations, and hectic fe ver, in from five to ten grain doses once or twice daily." its use. Jacobi then, it seems, entertains the same opinion as Bricquet, namely, that the infantile age especially tolerates large doses of quinia exceedingly well.† So far as I am able to judge from cases I have treated, this is correct in every particular. In this description of the prominent points to be kept in view in the use of quinia in the diseases of infancy, I would like to call attention to the fact that the rectum (having been previously emptied) absorbs it very well, especially if a rapidly diffusible preparation, like the muriate, be selected. In this manner the repugnance against the bitter taste of the drug is readily overcome. There is another obstacle which the physician often encounters in prescribing quinine extensively, namely, its constantly increasing price. This may be avoided by resorting to the amorphous chinine chinoidine-and I will say here that the preparation lately introduced into commerce by C. Zimmer, of Frankforton-the-Main, under the name of Chininum muriaticum * Daily Record of the Association of Naturalists, 1869, p. 175. amorphum, cannot be too highly recommended. It dif fers from the chinoidine salts heretofore used in the following important particulars: It is free from adulterations (very little lime from the water used in its preparation remains adherent to it), it is a powder, and in well-corked bottles may be kept dry for any length of time without becoming lumpy, and finally it is easily soluble in an equal weight of cold water. It is also free from the risk of being spoiled by mould, as all the other preparations of quinine and chinoidine, which require the addition of some acid to render them soluble. The price of this preparation, if my memory serves me, is but a tenth part of its namesake, the crystallized salt. Some experiments have been recently instituted with this preparation at the surgical clinic in this city, and the results obtained were very satisfactory. In fevers following surgical operations, sixteen grains of chinoidine, dissolved in an equal part of water, were injected subcutaneously. The temperature of the skin fell almost invariably, and no inflammation followed at the points of puncture. Only the bleeding was somewhat severer each time than ordinarily; this result is, however, undoubtedly due to the energetic relaxing effect which this preparation exercises upon the contractile elements of the walls of the vessels. This muriate of chinoidine of Zimmer has another disadvantage; its toxic effect— vomiting, ringing in the ears, etc.-ensues very quickly and in a very high degree through its use. This is mainly due, from all that I have observed, to the readi ness with which it is dissolved. This preparation is absorbed in the stomach quicker than any other, and thus flows to the head with such violence and rapidity as to affect the brain temporarily in the well-known manner. This disadvantage, however, if its cause be known, is readily obviated by exhibiting the muriate in small but oft-repeated doses, or in some vehicle that will retard its absorption; the addition of a little arabic answers this purpose very well. gum. THREE CASES OF IMPERFORATE ANUS, WITH REMARKS. BY J. H. POOLEY, M.D., Yonkers, N. Y. Of the malformations which demand early surgical interference a very large proportion are met with at one end or the other of the intestinal tract, either at the mouth or the anus. The former come mainly under the head of hare-lip in some of its variations, the question of interference at an early age with fissures of the palate being still an undecided problem of surgery, and all other malformations of the beginning of the alimentary canal and its orifice being too rare to be of much practical importance; the latter may be ranged under the designation of imperforate anus, a term preferable from its time-honored use and acknowledged latitude of signification to any involving an attempt at greater scientific accuracy, at least for purposes of general designation. It may be properly premised, however, that it were desirable for purposes of scientific precision that the obvious and not unimportant distinction between imperforate anus and imperforate rectum should be recognized and rigidly adhered to in all future descriptions and essays. Of the three cases I have to describe, only one belongs to the first category, imperforate anus, the other two ranging under the head of that commoner malfor mation imperforate rectum. Of these cases the first two occurred in my own practice, and within a day of each other, illustrating that curious law, if law it may be called, in virtue of which we so often see rare cases presenting themselves in close and unexpected juxtaposition. The third of the cases happened in the practice of a neighboring practitioner, and within a very short time of my own. The remarks which are appended to these cases are the result of the reading and reflection forced upon me by the emergency which called upon me for action, and turned my most serious attention to a subject which otherwise I might never have so thoroughly studied. Of course I shall make no attempt to statisticate the recorded cases of this congenital deformity; this has been too often and too thoroughly done to leave anything to be desired in the way of accessible material; but it seems to me that a résumé of the practical points connected with this subject affords material for important remark, and may profitably be brought to the attention of all general practitioners who may at any time, and without opportunity for study and consultation of authorities, be called upon to act in cases of the kind. |