genuity, and great ability of my learned opponent, I am compelled to say, that his philosophy does not stand the test of rigid examination, nor present any superiority over that of Newton. It involves principles equally mysterious, and has not the advantage, even, of greater simpli. city. We do not say that the Newtonian philosophy is absolutely true, in all its parts; but that, since it explains phenomena better than any other theory yet introduced, and since it involves no absurdity, we must adhere to it until something better is offered. What the labors of phi. losophers may reveal we know not. Doubtless great discoveries, and at no distant day, will be made ; and we trust that the profound re. searches of Professor R. may result in the discovery of important physical truths, and give much honor to liimself. The only fault we can find is, that he has engaged in the work of deduction rather too

The corner-stone of his philosophy is not yet laid, and the yarious parts of the edifice are composed of too frail inaterials, and often too slightly cemented together.


II. --The Remedial Powers of the Sulphate of Quinine. By THOMAS

D. MITCHELL, M. D., Professor of Materia Medica and Therapeutics in the Medical Department of Transylvania University. The first paper I wrote on the sulphate of quinine was published in the year 1825, in the American Medical Review and Journal, edited by Professors Eberle, McClellan, Smith, &c., a periodical that was not continued beyond the second volume. The article had then been a very short period in use, and it met with violent opposition. I had seldom given the Peruvian bark internally, and had relied exclusively on the preparations of arsenic, in all periodical affections, until experience assured me of the superior value of the sulphate of quinine.

In the paper referred to, several points were stated and defended, as follows:

1st: It cures the forms of disease in which bark has ordinarily been given, more speedily than any other medicine.

2d: It is more easily adininistered to all classes of patients than almost any other article employed in the treatment of fevers.

3d: It is a perfectly safe medicine, whatever be the age of the patient.

4th : It is less frequently followed by bad consequences than either bark or arsenic.

Lastly: It is cheaper than bark, and many other articles employed in the treatment of intermitting and remitting fevers.

The plan of treatment advocated for intermittents was that which has ever since been successful, viz., the exhibition of the medicine during the intermission, in such quantity as to prevent a return of paroxysm. To guard against relapses, I directed a grain or two of the sulphate to be taken every day, for five or six weeks, and this plan almost invariably succeeded.

I quote again from my paper of 1823: “But the opponents of the

sulphate of quinine have proscribed its use, chiefly, in the remitting fevers that lately prevailed so extensively. And here I feel myself authorized to say, the medicine manifested its superior excellence more decisively, to my mind, than in the ordinary intermittents. So confident was I in the powers of the sulphate in the remittents (called the bilious remittents), that if a choice of fever cases had been presented to me, I would have taken all the remittents, in preference to the intermittents. The course of treatment was plain, easy and successful. If called in immediately, I cleansed the primæ viæ at once by calomel and ipecacuanha, and then, by means of spiritus mindereri, set up a free perspi. ration, and so obtained a palpable remission. Occasionally, it was needful to precede the cal. and ipecac. by a moderate bleeding, especially if there was obvious cerebral determination. All this seldom consumed over twenty-four hours, and the favorable opportunity then presenting, I gave the sulphate as rapidly as possible. In two hours, I generally had the patient under the influence of a sufficient quantity of the medicine to prevent a return of fever, or to postpone it for hours, or to abate its severity, so as to insure its subduction, wholly, by a second use of the sulphate. Thus have I seen many cases (I might safely speak of hundreds) which at first seemed to be alarming, completely checked in a few days, so that the patient was about in less than a week, while others similarly attacked, perhaps under the same roof, but badly treated, were confined to their chambers from six to eight or nine weeks. In short, I did not meet a single case of fever, during the last season, that gave me any serious trouble, excepting such as had been previously under the care of a neighbouring practitioner, who cried the sulphate as poisonous, and whose practice was inert, and consequently unsuccessful.”

I quote again from the same paper: “ In short, I hesitate not to affirm, that no state of the system whatever can present a reasonable objection to the use of the sulphate, unless it be decided febrile action. Nor am I willing to concede, that even febrile action is an insurmount. · able barrier to its administration. I was called to see a young man who had been extremely ill of a remittent for two or three days, under the care of a neighbouring physician. The case had been treated with spt. minder. and ant. wine, in the proportion of half a tea-spoonful of the former to five drops of the latter, every two hours, unaided by other means, excepting active purgation. I found the boy almost speechless, with hot dry skin, dark brown furred tongue, suflused eyes, great un. easiness, frequent, weak pulse, approximating the typhoid character. I gave him active sudorifics, followed by blisters to the wrists, and yet the skin was hot and dry. I then ordered ten grains of the sulphate in solution, to be given during the night. On the next morning I found him evidently better, and a repetition of the same medicine carried him beyond the point of danger."

I have made these extracts from my paper of 1325, to show how the sulphate was employed at that date; and also because I design to refer to them in the present article, which has been prepared at the request of the East Tennessee Medical Society. It is proper to add here, that such was my conviction of the mal-practice then prevalent, that I read a paper in the winter of 1825–6, before the Philadelphia Víedical Seci.

ety, on Artificial Typhus, the chief aim of which was to prove, that the typhus or typhoid fevers, about whose fatality so much was then said, were, most commonly, the result of bad practice. I thought so then, and my opinion is about the same now, in reference to what is called typhoid fever, just as it was a few years since, in respect of that most popular disease called congestive fever, which seems to have passed away, in some unaccountable manner, and to have given place to a successor, so exactly like itself, that the difference is hardly greater than that between tweedle-dum and tweedle-dee. When I first came to Kentucky, in 1837, the chief mortality was from congestive fever (so called), which so closely resembled the remittents I had treated extensively and successfully with the sulphate of quinine, that for the life of me I could not perceive any real difference. Again and again did I urge the prompt use of the sulphate, after a suitable evacuation of the stomach and bowels, because I felt that periodicity was there, as I had seen it in hundreds of cases, and that the sulphate was its proper antidote. But the response was instinctive, “ that the time for quinine had not yet come ;'* " the tongue and the stools call for more cathartic medicine;" and thus the patients often fared worse than if they had been a thousand miles from the touch of a doctor.

We venture to indulge a little, just here, in the way of episode, to inquire, what has become of the terribly fatal congestive fevers that once desolated this region ? True, we are told, that those fevers were falsely named, and that they were, in fact, what are now called typhoid fever. Certainly, we never hear a physician speak of having a case of congestive fever on hand, now, in Kentucky; but, in every quarter, you meet with its substitute. The present typhoid fever, then, is precisely the same with the former congestive fever; and while the latter was very fatal, by reason of excessive purgation, and neglect to use the sulphate of quinine, the latter is equally mortal, because of the belief, that a do. nothing practice is essential to success.

I have said, that the congestive ferers from 1837 to 1842 were exact likenesses of badly treated remittents, as I first saw them over twenty years ago; and I now aflirm, that the typhoid fevers which have technically supplanted the congestive, are, in no essential feature, different. There has been a change of name, and a change of practice, to some extent, but I am not able to discover any favorable change in the results : in other words, the mortality is about as great from typhoid fever, as it was, a few years ago, from congestive fever.

But, says one, what will you do with the congestive fevers of the South? I reply, that the best writers on the spot, and familiar with the disease, have proved conclusively, the common origin of congestive, intermittent and remittent fevers; and their practice shows, most lucidly, that the very worst forms of congestive fever are paroxysmal, and that periodicity is the common basis. Hence, although there be diversity in respect of the use of the cold dash and stimulants, there is a concurrence as to the semi-omnipotent energy of the sulphate of quinine, to prevent a return of paroxysm, and so to save the patient. Those who feel disposed to cavil at the doctrine of the common origin of such fevers, and who tell us that intermittents are never seen in England and Ireland, will do well to read the statements of Dr. O'Brien, in the

Dublin Medical Transactions, vol. ix., p. 545. In the spring of 1817, intermittents (rarely seen for years) began to prevail in Dublin, pretty generally, whilst the ordinary continued fever (typhus) showed a strong tendency to assume the intermittent and remittent forms; and these three orders of fevers were converted into each other, in a new and extraordinary manner.'

I care not a straw for any argument to be deduced from post-mortem examinations of fever cases. Experience and observation have proved, long since, that no dependence, for successful practice, can be placed on such a foundation ; while both equally proclaim, that the true mode of meeting all fevers that are stamped with periodicity, whether more or less palpable, is by remedies, that so affect the organism, as to meet precisely that state of things, and to these remedies we have wisely given the title of anti-periodics.

With these preliminary remarks, I shall proceed to notice, more particularly, the uses of the sulphate of quinine, as a remedial agent; and, as my design is to present a practical paper, I wish to be understood as eschewing theory and speculation as far as practicable.

It is proposed to view the sulphate of quinine as a tonic, anti-periodic, and sedative, as we can present all that is desirable on the subject, most advantageously, under this arrangement.

On the tonic power of the sulphate, it is not needful to be at all prolix. We give it, in convalescence, as a remedy for pure debility, from any and every cause. We say it is a tonic, because it obviously aug. ments the general tone and vigor of the system. It displays this feature, very frequently, in the stomach, before we perceive any decided consti. tutional manifestation. The appetite is revived, the digestive powers excited into more healthful action, and the work of assimilation is more complete and natural. It might be affirmed, that the remedy in these developments is truly an alterant, because it is gradually effecting most happy changes. We are aware, that every tonic is necessarily an alterant, and the persistent use is essential to the desired result. Hence, we give the sulphate, as a tonic, not for a few days, but for weeks, in small doses at first, and then gradually augmented. Ordinarily, we prescribe from half a grain to a grain per day, or oftener, according to circumstances; and slowly increasing, we give it, at length, in doses of two or three grains. This course of procedure is safe and successful, in ordinary cases.

As an anti-periodic, we hold the sulphate in much higher estimation. Does any one inquire, what we mean by anti-periodic? We have already eschewed theory and speculation, and shall reply by reference to palpable facts. Ague and fever is held to be a periodical disease, or a disease of periodicity. Nobody doubts this. A man has it one day, is well the next, and sick on the third day, and so the chain continues for months, unless you strike out a link or two, by remedial agency. On the well day, the man takes sulphate of quinine, and is cured. A thousand do the same, and all get well. The facts prove that periodicity was the grand basis of the morbid action, somehow or other; and they equally prove, that the sulphate of quinine has broken the morbid asso. ciations, and this is exactly all we mean by an anti-periodic. The term is applicable to all periodic diseases, that are curable by medical means. If any still inquire, what is the essence of periodicity, we reply, that

Hippocrates knew just as much about it as the wisest man now living, and that we have no valid reason to hope for more certain knowledge on the subject. The facts are all we know; they are readily tangible, and we have an undoubted right to use them for the best practical ende, whether we fully comprehend them, in all their bearings, or not.

The anti-periodic power of the sulphate is variously developed. Where the morbific agency is comparatively feeble, and the diseased associations not bound as by an iron band, small doses generally answer all desirable ends. But where the opposite state is present, the success of the medicine will depend very much on the size of the dose, and the quantity introduced into the system, in a given time. I say, introduced into the system, for the purpose of embracing the endermic use, as well as that by the mouth and rectum.

The following case furnished by my son, B. Rush Mitchell, M.D., now of St. Louis, Mo., is in point. It occurred in his practice at Madison, Ind., in the summer of 1845.

“ Mr. S—, aged 35, returned from the South to Madison, and was attacked a week after, with a slight chilly sensation, succeeded in a few minutes by an intense and long-continued chill, little subsequent fever, and no perspiration. I did not arrive while the patient was in tho paroxysm, but learned from those present, that throughout the whole of it there was scarcely any pulsation at the wrist. The countenance was cadaverous, tremors constant, a total lack of motive power, and the entire surface of an icy coldness.

The aspect of the case was very much that of a dead or dying man. Calculating that it was a case of severe intermittent, I left twenty grains of the sulphate of quinine, to be taken in five-grain doses, every hour. I was summoned on the next day, with the tidings that the paroxysm had recurred with great severity; and finding the symptoms much more appalling, I became alarmed for his safety. I determined to remain all night, as the paroxysm began about 10 p.m.; and fearing another would be fatal, it was my fixed purpose to put the sulphate to the test. At 5 in the evening, I began with thirty-grain doses, and repeated them every half hour. As no untoward effect was manifest, these were continued until 9 P.m.; and now, having administered 240 grains, I thought if the patient was not safe from another fit, medicine could not save him. I discontinued the sulphate, and watched the case till the dreaded hour passed by. There was no recurrence of paroxysm, and I retired to rest. On the next day, the sulphate was renewed in small doses, and continued for threo days, with the effect of complete restoration to health."

I regard the foregoing case as one of vast interest. In about four hours, two hundred and forty grains of the sulphate were administered, with no developments of bad symptoms, and with the effect of perfect recovery from a most alarming grade of what would be called, in many parts of the South, congestive fever. The case is a good illustration of some points made and forcibly expressed by the late Dr. Johnson, in his excellent work on the diseases of tropical climates. The patient, from residence in the South, had acquired a fixed predisposition to fever. The elements, thus far, were incorporated with his being, and all that was needful to display morbid phenomena, was a sufficient exciting cause. That was realized in a change of residence to a region de.

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