LECTURES
SULPHATE  OF  QUINIA:
Delivered in the Regular Course of the Medical Department
           of the University of Michigan,
     A. B. PALMER, A.M. M.D.
Professor of Materia Medioa, Therapeutics, and Diseases of Women and Children.
PTJBIISHED BY THE CLASS.
           .I"'' '/f-
       DETROIT, MICH.:
FLEMING & DAVIS, BOOK PRINTERS,
         No. 52 Sf)«H>8 Strtrt.
             1858. 
 
PREFACE.
As  more copies of the following  Lectures will be printed
than will be  required  by the gentlemen of the  Medical
Class who  publish them, the Author wishes to  say  a few
words to others of the Profession whom they may reach.
    Although  the views contained in these  Lectures have
been well  considered  and  are  deliberately  entertained —
are, indeed,  the result of much  observation,  experience,
and reflection, — yet the  language in which they are here
presented has been most hastily prepared.   The manu-
script notes from which  the  Lectures were  delivered con-
tained  only the outlines and some of the leading thoughts,
sketched in an abbreviated form—the full expression  of the
ideas, and the methods of their illustration and enforcement,
having been left for the occasion of their presentation;  and
in writing' them out for the press,  so as to have them ready
for  distribution before  the approaching dispersion of the
members of  the Class  who desire them, very little time
has been afforded—and, as the manuscript was sent  to the
printers as fast as written, there  has been no opportunity
for  revision,  except such as may be presented in reading 
VI
Preface.
 the proof.   Should defects in style or arrangement be ob-
 served,  it is hoped  these circumstances will  be taken into
 the account in modifying the severity of criticism.
    One thing more.   These Lectures are not presented as
 a complete  Treatise on Quinine;—they are offered  simply
 as a few Lectures on a single article, taken from a  Course
 on Materia  Medica and Therapeutics, necessarily restricted
 within certain limits,  and presenting views on the subject
 regarded as most important  to  be understood.  Lectures
 to Students, in order to arrest their  attention and impress
 the opinions of the  teacher upon their minds, must be,  to
 some  extent, dogmatic in manner, and  they  do not admit
 of that full  citation of authorities, and that elaborate  pre-
 sentation of all  the facts and processes of reasoning upon
 which conclusions are  based,  as  should be afforded in an
 extended Treatise.
   With these explanations,  this  humble  contribution to
 Therapeutical Science  is now offered to Students and the
Profession. 
Cflrmpnhttn.
                                   UNIVERSITY OF MICHIGAN,
                                            Ann Arbor,  December 5th, 1857.
Prof.  Palmer:

        Respected Sir, — The members of the Class of the Medical Department of
the University of Michigan, being much interested in and highly pleased with your
practical Lectures upon Quinine, just delivered, have  appointed  the undersigned a
Committee to request said Lectures for publication.
    Believing as we  do that their  publication would supply needed literature upon
this important article of the Materia Medica, and be most beneficial to ourselves, we
hope you will not refuse our request,
                          We are, very truly, yours, &c.

                                                  H.  M.  Darling.
                                                  Thomas  Lothrop,  jr.
                                                  J. J. Comfort.
                                   UNIVEKSITT  OF  MICHIGAN,
                                            Ann Arbor, January 18th, 1858.
Prof.  A.  B.  Palmer:

       Dear Sir, — At a meeting recently held by the  students of the Medical Class
of the University of Michigan, for the purpose of renewing efforts to secure the pub-
lication of your Lectures  on Quinine, W. E. Thompson, of Indiana, was called to the
Chair; when, on motion, it was unanimously

     Resolved, That whereas we deem the Lectures of Professor A. B. Paijher on Quinine superior, in
a practical point of view, and especially so to those who expect to encounter diseases in the West, to anj
articles on the (abject which are found in the Standard Works, a Committee he appointed, consisting of
the undersigned, to again solicit a copy of said Lectures for publication, and, if the request be granted,
to make arrangements for the same.

     Trusting that you will see fit to comply with the wishes of the Class, as expressed
in the resolution,
                      We remain yours, with respect,

                                                   Jona.  J. Comfort,
                                                   E.  M.  Winslow,
                                                   M.  L.  Greene,
                                                                Committee. 
iv
Correspondence.
                                   UNIVERSITY  OF  MICHIGAN,
                                            Ann Arbor, January 27th, 1858.

Messrs.  J.  J. Comfort,   E.  M. Winslow,
                                           and  M.  L.  Greene:

        Gentlemen, —Your note of the 18th instant, asking, in behalf of the Medical
Class, for a copy  of my Lectures  on Quinine for publication, was duly received, as
well as one from a previous  Committee of the same body on the same subject.
    Having had personal interviews with  the  first Committee, I did not in writing
answer their communication ;  and thinking, after the  lapse of some time, the Class
might not regard  the  publication of the Lectures of as much consequence as  they
still seem to do, I have deferred until the present a definite reply to the requests.
    For the purpose of gratifying the repeatedly - expressed wishes of the  members
of the  Class, rather than my own,  I have  concluded to prepare and place at  your
disposal a copy of the Lectures.   In presenting them in a form separate  from the
Course of which they constitute a  part, some  modifications of arrangement will be
necessary, to give any thing like unity  and completeness to the subject; but, while
this is  done, the same thoughts and expressions will be preserved, and as much as
Is consistent of the original order.
    While I am highly gratified with the manner in which the Lectures were received,
I fear that, when reduced to writing and presented in print, they will fail to sustain the
impression their delivery produced.   In  the clearness and impressiveness of all oral
communications, so much depends  upon associations, manner, emphasis, repetitions
and illustrations — upon  circumstances and  qualities which can not be expressed by
types,—that often what appears as somewhat novel and striking when heard, is found
to be more  tame and commonplace when read.  But, notwithstanding this, I present
these Lectures, through you, to the members of the Class, and hope, as they contain
practical  opinions, which are the result of  much observation and experience in the
application  of  a most important remedy to the prevailing diseases of the West,  they
will be a useful guide to yourselves, as young Practitioners, and will be found to cor-
roborate the more  enlightened views of the observing and thinking members of the
Profession, if they do  not establish much that  is positively new.
    With the  most grateful  emotions to the Medical Class  for the uniform kindness
and attention they have shown me, and for the flattering manner in which, through
their Committees, they have expressed their appreciations and feelings,

                I am, very  truly, their and your obedient servant,
A.  B. Palmer. 
SULPHATE   OF   QUINIA.
             --------•-»-•--------

               LECTURE  I.
Gentlemen:
     We come now to consider the most important ingredient
in that highly complex substance, Cinchona, or Peruvian Bark,
viz., Quinia, or, as it is commonly combined and called as used
in Medicine, the Sulphate of Quinine.
   Although the Peruvian Bark has been used among Euro-
peans for over two hundred years, it is scarcely half a century
since it was analyzed, and its alkaloids were discovered,  separa-
ted, and examined by themselves.  The French  chemist  Pelle-
tier has the honor of the discovery of Quinia,  and Magendia
first experimented with it upon animals, and ascertained some
of its relations to the vital organism; and it having been ascer-
tained  by these means to  be not actively poisonous, and the
inference having  been  drawn that it possessed the virtues of
the Bark,  it was soon introduced into Medicine, and for the
last thirty or forty years has been a leading article of the Materia
Medica.
   The great prevalence in this country, and particularly in the
West, of the diseases to which it is  more especially applicable,
and in which it is so peculiarly efficacious, caused its intrqduc-
tion here to be hailed with great joy.  The late Dr. Harrison,
of Ohio, depicts in glowing terms the joyful manner of its re-
ception in his  locality;  and, although  prejudices  have arisen 
8            Lectures  on Sulphate of Quinia.
which it has had to encounter, it has steadily increased in favor
as it has become better known, and not a year  passes which
does not add to the sphere of its application in disease and its
reputation with the Profession.  The importance of this article
is such—its power  of counteracting disease, when properly ap-
plied, is so great—that you will do well to give  special atten-
tion to what may be said respecting it.
    The mode of preparing the Sulphate of Quinine from the
Bark, you  will receive  from the Chair of Pharmacy, and  may
also find, at any time, in the books.  Under the proper manip-
ulations and actions of reagents, the  Yellow Bark yields  from
one and a half to three  per cent, of the salt.   It occurs in  very
fine, needle-like,  silky,  flexible crystals,  of  a perfectly white
color, as you see, and which are inodorous and have a very bit-
ter taste.   Exposed to air, these crystals effloresce slightly; by
being mechanically pressed, as by carrying about one's person,
they are easily broken down, and occupy a smaller space;  by a
moderate heat they are  fused, and by red heat are decomposed.
    This article requires for its  solution 740  parts of cold, but
only 30 of boiling water, and it gives a blue tinge to the water.
It is soluble in about 60 parts of alcohol, and is very soluble in
dilute sulphuric, or  almost any of the other acids.  A few drops
of  elixir vitriol, or a few grains  of tartaric acid, added  to a
drachm of Sulphate Quinine, will render it  soluble in a small
quantity of water.
    Its chemical composition,  as given by Prof. Wood, is, one
equivalent of sulphuric  acid, 40, one of quinine, 324, and eight
equivalents of water, 72 = 436.
    The physiological actions of all medicines should be studied
with care, as a  knowledge of the  impression they make  upon
the organism  in its normal condition  is essential to a full  philo-
sophical understanding of their therapeutical effects—of the
manner of their operation in disease.   Though we may  learn
empirically, from simple observations upon the sick, that a cer-
tah/powerful medicine usually controls particular morbid pro-
cesses, we are but  illy prepared to prescribe safely such article 
Lectures on Sulphate  of Quinia.            9
in the varying conditions of the system attendant upon any dis-
ease, unless we know the particular action of that  article upon
the system in health — the  specific effects which it tends to pro-
duce upon all the different  organs of the body.   Your attention,
therefore, will be, first, though briefly, called to a consideration
of the best ascertained physiological effects of this article.
   The first experiments made with Quinine  upon the lower
animals, seemed  to indicate that  it was quite  harmless in  its
action; later observations,  however, have shown that in certain
large doses it proves fatal to animals.   Melier found that it
could be made to produce  stupor,  staggering, or sudden falling .
down, dilatation of the pupil, coma,  varied  conditions of the
pulse,  convulsions, and death.  The post-mortem  appearances
were, congestion of the lungs, and deficient coagulability of the
blood.  We may observe some analogy between this congestion
of the lungs in the poisoned animals and the sense of stricture
in the chest which is sometimes, though not very frequently,
experienced  in the human  subject when under the influence of
Quinine.
   Given to man, it occasions a pure, though intensely bitter
and somewhat persistent taste, and in small doses it usually pro-
motes the appetite and  assists digestion.  It seems to possess
the properties of other simple bitters,  and, in moderate doses,
doubtless acts as a tonic. By a tonic, you understand a medicine
which does not so immediately call forth action like stimulants,
or depress it like  sedatives, but one which  gives power to the
system to generate nervous force, by which the whole body is
strengthened.  Quinine  then, used in  this  manner, is a tonic,
giving  strength—not merely a stimulant, calling  it forth.  It
does  not merely excite action, as action is not strength—over-
action having the effect to increase exhaustion—but it gives,
like all true  tonics, the power to act.   This effect may depend,
to a great extent, upon its improvement of the appetite and in-
creased digestion, or possibly upon some more direct restorative
effect upon the blood; but, in  some degree at  least, the tonic
action is accomplished by its direct impression upon the general 
10           Lectures  on Sulphate  of Quinia.
nervous  and muscular systems.   This tonic  action is realized
when Quinine is given in doses of one grain three times a day.
    In  large doses, as from five to twenty or  more grains, Qui-
nine produces other effects—effects which in their results are
different in kind, as well as in degree,  from those  produced by
small doses.  In these larger doses, it  is capable of a somewhat
mixed  and peculiar, though in many respects a decided sedative,
operation.   This sedative  action of Quinine is constantly wit-
nessed by those who are in the  habit of administering it in large
doses in disease, and has been further  substantiated  by some
experiments of Briquet upon dogs, in which he found that when
from seven to thirty grains were, in solution, injected into the
external  jugular veins of these animals, the force of the heart's
contractions was diminished in proportion to the quantity used—
seven grains having but little effect, while thirty grains caused
speedy death by syncope — the heart ceasing  to act altogether.
It should be mentioned that in  other experiments, where similar
solutions were made to enter directly the cerebral vessels, the
brain was  excited, and the force  of the heart's pulsations was
somewhat  increased.   These facts taken together show, what
we shall  have occasion to refer to again when speaking of the
therapeutical application  of  this  article, that it  may  operate
either as an exciting or a depressing agent, depending upon the
condition of the system, the dose given, and  the  particular or-
gans on  which it acts; that  in the same  case it  may depress
some functions, while it sustains others.
    Quinine has sometimes produced Gastro-Miteric Irritation^
marked by pain and heat in the gastric region, nausea, griping,
and purging.
    Constipation has sometimes been thought  to have been pro-
duced; and a kind of  Salivation also, but with firm teeth and
inodorous breath — but these latter results are so rare, if they
exist at all as the effects of this article, that they  are not to be
taken into the account in prescribing  it.   I have seen no other
salivation induced than that which arose from  the bitter taste of
the medicine left in the mouth. 
Lectures on Sulphate  of Quinia.           11
   Irritation of the Gastric Membrane, without the accompa-
nying  intestinal  irritation,  not very unfrequently occurs,  or,
rather, is sometimes aggravated where it already exists, on the
administration of Quinine;  and these effects, according to my
experience, are about as likely to occur from three or four grain
doses,  as from doses of eight, ten, or more, grains.  But  these
irritating  effects  upon this surface can almost always be pre.
vented by combining Morphine with the Quinine.
   Excitement of the Vascular System, manifested by incrdease t'L
frequency and fullness of the pulse, augmented respiration, heat
of the surface,- furred tongue, and other symptoms of a febrile
state, are sometimes, or in certain conditions of the system, pro-
duced by Quinine, when given in doses of from two to four or
six or more  grains, repeated every second or third hour, or a
grain or two  once an hour.  If a paroxysm of fever be present,
or an inflammatory irritation, or a fullness of the system, and
especially when no  miasmatic influence is operating as an  excit-
ing cause of these  states, these effects of excitement are  more
likely to occur.   In the intermission of a miasamatic fever, how-
ever, even when there is  considerable local irritation, such
effects are seldom  produced,  especially if the Quinine be com-
bined  with Morphine and relaxing diaphoretics.
   Disorders of the  Cerebro- Spinal  Functions are not unfre-
quently produced by  Quinine, indicated by headache, giddiness,
contraction,  or, sometimes, dilatation of the pupil, ringing or
roaring in the ears, deafness, partial blindness, abnormal  touch
and  smell, difficulty  of controlling muscular acts, somnolency,
sometimes delirium,  at  other  times stupor.   As already inti-
mated, a severe sense of stricture about the chest is sometimes
experienced.   These  effects are, for the most part, temporary,
and pass off  like  a fit of intoxication, but in some rare instances
they  are more permanent.   Such effects  are sometimes  called
Quininism.
   A fatal case is reported to have occurred  in the Hotel Dieu,
Paris,  where a patient with rheumatism, who had taken one
hundred grains in  the course of a day and a half, in  divided 
12           Lectures on Sulphate  of Quinia.
doses, was suddenly seized with violent agitation, followed by
furious delirium, and death in a few hours.
   Another fatal case is recorded, where a medical practitioner
in France, imagining himself about to be attacked with perni-
cious intermittent fever, took nearly two  ounces  Troy, which
produced much prostration. Attributing this prostration to the
fever, he continued the medicine, taking in the course of nine
or ten days five additional ounces.    He  was then found by
another physician,  covered with cold sweat, completely  deaf
and  bhnd, in a profound  stupor, with a drunken expression  of
countenance, and difficult and  rattling respiration.   Though
partially  aroused with much difficulty, he quickly  became  deli-
rious, and died.
   In another case, where ten drachms and a half were taken
in the course of a few days, the patient  lost, for a time, sight,
hearing, and speech, and became cold as a corpse, but recovered.
Dangerous consequences have been reported by  others; but,  in
a large  experience  with the article, of nearly twenty years, I
have never seen any dangerous effects,  though I have never
given it  in such  enormous doses.   Enormous doses,  as of an
ounce or  more in a few hours, have been  given, however, ap-
parently without injury.   In  many  of these  cases, doubtless,
only a part of the medicine was absorbed,  yet very large quan-
tities may be taken into  the  circulation  without  serious  con-
sequences.
   In consequence of some of these effects upon the brain and
nervous system just described, Quinine has been  called a nar-
cotic—& medicine which you understand to be defined as first
stimulating and then depressing vital action, and which  acts
upon the intellectual part of  the  brain.   Quinine,  however,
scarcely answers to this definition, though in  some respects it
certainly approximates to the action of narcotics.  In certain
doses and instances, and generally in relation to some functions,
it acts as a stimulant—in other doses and instances, and  in
relation to other functions, it  certainly acts as a sedative; but
it does not, in any ordinary quantities, particularly affect the 
Lectures on Sulphate  of Quinia.           13
intellectual functions, producing either  inebriation,  sopor, or
delirium; yet,  in  very  large  quantities, probably by causing
congestion of the brain, it may and does produce some of these
results.  It does not, however, like alcohol, when this article is
taken in quantities sufficient to produce its more characteristic
effects, produce at first  marked increase, and then as decided
diminution, of action,  together with the unequivocal phenom-
ena of inebriation;  nor, like  Opium, when this latter is  given
in full doses, does it cause that general  exaltation  of action,
followed by such certain and  speedy diminution of power, with
slow  breathing and heavy sleep;   neither,  like Hyoscyamus,
when this narcotic is given in its proper  free doses, does the
Quinine  produce that slight and transient  excitement, followed
by that peculiar and protracted depression of the general pow-
ers and that marked derangement of the intellectual functions,
so commonly present under the influence of the Hyoscyamus,
called delirium.   Though  both stimulation and  sedation are
among the actions of Quinine, they do  not  follow each  other
in the same order, and are  not  attended by  the  other phe-
nomena  which  characterize  the operation of  either of these
representative  articles  of the  three  groups of narcotics, —
Inebriants,  Soporifics,  and  Deliriants.
    I  shall not now enter into the discussion,  and much less
attempt  positively to decide the question,  whether the sedative
effect  of Quinine  is usually primary and  direct, or secondary
and indirect, as  the consequence  of over-stimulation of the
brain.  I shall content myself with stating  the fact, that the
result of a full quantity of the article is,  under many circum-
stances,  a sedative  influence  on most of the functions, and, in
general, with safety to the brain.  In many states of the system
then, and I can say and assure you that  generally in doses of
from five, ten, to fifteen grains, Quinine  acts  as a peculiar sed-
ative, rendering the pulse softer and slower, diminishing mus-
cular strength, relaxing the general system, causing free per-
spiration, reducing inflammatory action of a certain grade and
kind, and producing a general quieting  effect. 
14           Lectures on Sulphate  of Quinia.
   The circumstances calling for the administration of this arti-
cle for its sedative effect, I shall endeavor to point out in a sub-
sequent Lecture.  What I wish to do now is, to impress you
with the fact that Quinine, in  large doses, is capable of pro-
ducing these sedative results; and I may here add that  these
results are  decidedly increased by combining with it full  doses
of Opium, Dover's Powder, or Morphine.
   Quinine has  a decided effect upon several of the secretions.
I have just said that in free doses it increases the exudation
from the cutaneous surface.  It often does this in a very decided
manner, and a part of its remedial effects is due to this mode of
its operation.
   It modifies,  not less decidedly  perhaps, the action of the
kidneys.  When Quinine is taken in considerable quantities
into the stomach, it is soon found presenting itself in the urine.
This is  the principal channel by which it is removed from the
system; and  it is  asserted by some, that its more perceptible
effects upon  the organism cease when it no longer appears in
that fluid.  In passing through the various tissues of the body,
and out at the  kidneys, it  so modifies the organic molecular
actions, — the metamorphic  and secretory processes—as to in-
crease, it is said, the solid constituents of urine.  Experiments
and observations for the purpose of establishing this point have
not been numerous;  but, not long since, I  read, with much
interest, an article in a southern Medical Journal, from the pen
of a young man like one of you,  detailing experiments made,
I believe, during his pupilage, which went far to establish the
fact just referred to.  A young man can  make experiments and
collect facts as well  as  an older one; and I hope none of you
will be deterred in consequence of your youth from doing what
you may to advance the Profession of your choice.  It would
not be a difficult matter for any of you to test this point.  For
instance, let  your food and drink  be  carefully and properly
selected, and accurately weighed; let your exercise, rest, ex-
posure, temperature, &c, be regulated by a standard; avoid all
medicines; and analyze the urine, qualitatively and quantita- 
Lectures on Sulphate  of Quinia.          15
 tively for  a few days: then  take a given  amount  of Quinine
 per day for another period,  continuing  every thing else  the
 same, and, by the same analytical processes, ascertain the re-
 sults upon the urine.  A sufficient number of such experiments
 would bring you to the  truth.   Something of this kind was
 done  by the young man I have referred  to,—the effects of
 Quinine  upon the urine of several persons  were observed, and
 the conclusion was  arrived  at  that the  article increased in  a
 decided  manner the solid constituents of the secretion.  Con-
 sidering the fact, that a large portion of the worn-out materials
 of the tissues are removed from the system by the kidneys,
 and the  morbid  effects which the retention in the organism of
 effete materials produces, the therapeutical value of this quality
 of Quinine can readily be  imagined.   Now, the fact as to this
 effect of Quinine needs more confirmation;—may we not hope
 that some of you will furnish it ?
    Other secretions are increased by this article.  It operates
 not unfrequently as a Cholagogue—increasing, not as decidedly
 as some other medicines, but yet very perceptibly, the secretion
 of the liver.
    The  Gastric  and Intestinal Secretions  are unquestionably
 often, if not uniformly, promoted by it, and, under  proper cir-
 cumstances, probably all the other secretions of the body.
    The Menstrual flow is often promoted by it; and my friend,
 and the  ardent friend of this Institution, Dr. Z. Pitcher, the
 Emeritus Professor  and Clinical Instructor of this University,
 regards it as one of our most efficient emmenagogues.  He pre-
 scribes it for this purpose, and with much success.  Dr. Pitcher
 also regards Quinine as having a peculiar  effect, through the
 nerves, upon  the molecular changes  in the  tissues,  correcting
 morbid and favoring healthy ultimate nutrition; and often pre-
 scribes it, with reference to this action, in chronic diseases de-
 pending  upon changes in the secretory and  nutritive processes.
In cases  of struma, tuberculosis, &c, he often gives it in doses
of from two to four grains a  day, for many months together;
and  is able to refer to many cases  as  evidence of its good
effects, given  in this manner. 
16           Lectures  on Sulphate of Quinia.

   From the account which I have thus endeavored to present
to you of the peculiar actions of Quinine upon  the different or-
gans and functions of the body, many of its uses in Medicine
may be inferred;  and in the next Lecture I  will  proceed to
consider, more particularly, its relations to disease—its actions
as a therapeutical agent. 
LECTURE II.
Gentlemen:
     At the last Lecture, your attention was occupied with a
brief account of the source of Sulphate of Quinine, its  physical
properties and chemical composition, and its action upon the
living organism in its physiological state; and, by the manner in
which  you have answered the questions just put  to you, you
have furnished gratifying evidence of having understood and
remembered the  statements presented.   We are now prepared
to proceed to a more particular consideration of this important
article, in its therapeutical relations.
   To the powers of Quinine in modifying and controlling dis-
eases, and the mode of its application in the various cases  re-
quiring its use, I have  given  no small amount of attention.  I
have observed its effects, as administered in different doses and
combinations, in a great variety of diseased conditions,  and in a
very large number of instances.  Practicing, as I did, in this
State for several years when the diseases to which this article is
particularly applicable  were  very prevalent,  and for  several
years more in the  metropolis of Illinois and the North-West,
where its use was daily  required, I have  perhaps had more op-
portunity of studying  its actions than  many of those distin-
guished  gentlemen on the  Atlantic sea-board, or in Great
Britain, who write  our  text-books; and, while  I have  endeav-
ored not to  overlook any of  the important literature on this
          B 
18           Lectures on  Sulphate of Quinia.
subject, I  shall express to you no decided opinions which have
not been  tested and confirmed by my own experience and ob-
servation.   But, independent of this,  the intrinsic importance
of the subject requires me to  ask your particular attention to
what may be said upon it, as I shall urge upon you  also to give
special attention to other leading therapeutical agents, such as
opium, mercury, cathartics, and the hygienic remedies.
   The most important therapeutical power of Quinine is that
by which it controls diseases manifesting in their course marked
periodicity;—and hence I have  placed it under the head of
Antiperiodics.
   [I shall here introduce some remarks  which were made on
the general subject of Antiperiodics, introductory to a con-
deration of the particular articles of that class.]
   Antiperiodics are medicines designed to remove the element
of periodicity in diseases, or which are given for the purpose of
interrupting those diseases which are marked by decided par-
oxysms, occurring, or tending to occur, at stated and regular
intervals of time.   Nearly all diseases  are, to a greater or less
extent, periodical—that is, they have periods, commonly diurnal,
more or less  perfectly manifested, of exacerbations  and abate-
ments.  There has been no  little discussion among medical
writers as to the cause of this general tendency to periodicity in
diseases, and  many ingenious, and several  plausible, theories
have been proposed.  I could not stop to enumerate all these
hypotheses,  extending back, as they do, to  the period when
almost every thing in Pathology was accounted for by the quali-
ties, changings, and mixings of the four humors, even  if I could
now call them all  to mind.  It should be remembered that in
health there is a rhythm of the vital processes—there are periods
of comparative activity and repose of all the  organs and func-
tions, and the diurnal habits of sleeping  and waking, of labor
and repose, of food and abstinence, and the like, give a tendency
to diurnal fluctuations in diseased actions.  In some diseases,
the morbid cause probably operates rythmically;  in others, the
periodicity in symptoms depends upon  the changed function of 
Lectures on Sulphate  of Quinia.           19
an organ whose healthy life is periodical; while to a greater or
less extent, in perhaps all  cases, morbid organic periodicity de-
pends upon an influx and accumulation of nervous power in some
irritated part,  producing symptomatic phenomena, which by
violence of action exhausts, in a given time, the excitability of
the part or of the system generally, requiring repose for a time
before being  capable of  responding again as  actively to  the
morbid impression".   In  this  view,  the  intermittence  is  the
fatigue, the repose, the sleep of the nervous system, under  the
more or less continued influence of a morbid  irritant.  During
this rest, the nerves recuperate  their suspended energies, and
re-acquire their susceptibility  to  the morbid impression, and
regain their power  of causing other parts  of the organism to
respond in various abnormal actions.  It is  rational to  suppose
that thus general periodicity,  or rhythmical fluctuations, occur
in the common course of diseases.
    But the periodicity now to  be considered in connection with
this distinct class of remedies which we designate as Antiperiod-
ics, is more distinct and marked than that which belongs to dis-
eases in general, and is believed to be produced by a distinct
aerial poison, which has been called Marsh Miasmata, Malaria,
Paludal Malaria, &c.  This subject has been discussed, I have
no doubt, ably,  and  probably sufficiently, from the Chair of
Pathology and Practice.  I shall not enter into the proofs of its
existence, its probable nature  or composition, its mode of con-   r
veyance, its particular action  upon the system, or the circum-
stances which favor  the production of its effects.  I will simply
say that the evidence is fully sufficient to convince me that there   .
is such a poison, and as, too, in accordance with  the general
opinion of the Profession, I shall assume its existence.
    This miasm presents itself in different degrees of concentra-
tion and power, if it be not of different kinds, from that which
produces the mildest effects — such as moderate indispositions,
derangement of secretions, slight "aguish feelings," mild neural-
gies, <fcc. — to  those malignant congestive  fevers which some-
times, like a stroke  of apoplexy, crush out in a few hours the 
20           Lectures on Sulphate  of Quinia.
vital spark.  While the effects of this  poison are sometimes
trivial  and almost imperceptible, they are, at  other times, the
most violent that can be well imagined; but in all instances, for-
tunately, they are  more under  the  control of proper remedies
than most other morbid phenomena of apparent equal severity.
   A great variety of agents may  operate as  Antiperiodics —
may break in  upon periodicity of symptoms  caused by this
malaria,  and may produce  their effects in  a great variety of
ways.
   When the poison causing these symptoms is feeble, and pro-
duces but slight derangement, a resort to any article of medi-
cine which may remove a  predisposing cause, or arouse  the
energies of the system, or in almost any manner decidedly im-
press it—'Such as a gentle1 alterative and cathartic, a saline which
shall affect the  secretions and  depurate the blood, an emetic
which shall impress the nervous system and operate as an alter-
ant, a plunge-bath, a favorable  change of air, a gentle tonic, a
change of diet, or a strong and  exhilarating  mental emotion —
may enable the  system to resist the effects of  the  poison, and
restore the balance of healthy action.  When, again, the poison
has nearly exhausted  its force, and periodical symptoms recur
from habit, almost any thing that will perturb the system—that
will break in any manner upon its  morbid associations — may
restore the actions to their normal condition.
   But I now propose to use the term Antiperiodic in a sense
more restricted  than that which would embrace so large a class
of agents as have just been alluded to.  I mean by this term, in
its technical  sense, a  medicine  which, by being taken into  the
system, enters the blood, and,  when there, either by an effect
which  Headlaj^)  calls catalytic, directly destroys or renders
inert a morbid material, the  cause of periodic symptoms, or sets
in action a chain of processes which accomplishes that destruc-
tion;  or, by  what is called  a restorative action, supplies some
wanting  material  in the blood, or causes  it  to be supplied,
whereby this tendency to  periodicity of symptoms, its cause
and  consequences,  are overcome;  or else a medicine,  being 
Lectures on Sulphate of Quinia.          21
applied to the nerves and nerve  centres,  so impressing them
as to materially modify or overcome the effects of the morbid
cause, rendering the nervous system insusceptible to the morbid
impression of the poison, and thus causing it to be inoperative
in the production of the ordinary phenomena of these periodical
or miasmatic diseases.
    According to this view, Antiperiodics proper may operate
in three ways: — 1. By destroying a poison in the system, or
changing a morbid process existing there;  2. By restoring, or
causing to be restored, a deficient  element or quality in the
blood, or some  necessary process in the system;  and, 3. By
so impressing the nerves and  nerve  centres as to render the
system, in a greater or less degree, insusceptible to the impres-
sion of the miasmatic poison.   According as the medicine ope-
rates in one or the other of these ways, it becomes a Catalytic
Haematic, a Restorative Haematic,  or a Neurotic.
    That an Antiperiodic may have other  powers, and produce
other effects  upon  the system, of a curative nature, than those
just indicated, is admitted; but the symptoms of periodicity, it
is rational to  suppose, are removed in some of these ways.
    The phenomena by which a miasmatic influence in the system
is indicated, and the particular circumstances calling for the use
of Antiperiodics, I  shall not dwell upon systematically and in
full detail, as these matters more particularly belong to another
Chair; though I intend to point out the most important indica-
tions for the  use of  this class of remedies, and the  mode of
their application.  The whole subject of malarial diseases, how-
ever, is one of deep interest to all,  and especially to those of the
West; and I hope  you have given, and will continue to give,
especial attention to it.   In former years it has been the case,
it is so now  in  many localities, and  may even be generally so
again, that throughout the West,  from July to November, the
prevailing, the almost exclusive, diseases were of a miasmatic
character; and, at all seasons and  times,  a large portion of
Western  diseases having other origins  are  decidedly modified
in their  symptoms and proper treatment  by  the  miasmatic
influence. 
22           Lectures  on Sulphate  of Quinia.
    Now, in general terms, it may be stated, that whenever in a
 region where intermittent diseases, as agues, <fcc, are known to
 prevail, a marked, decided, and, what would be in other situa-
* tions, an unusual periodicity of symptoms  is present in the pro-
 gress of a disease, whether that disease be a fever, a neuralgia,
 a diarrhoea, a dysentery, a congestive pneumonia, a bronchitis,
 or even a cutaneous eruption, an  antiperiodic of some  kind  or
 another is called for.  This statement is based upon the supposi-
 tion, that wherever the miasmatic  poison prevails, it may be
 present in, and more or less impress, the systems of all  persons,
 and that when a disease, of whatever character, is present, the
 malarial poison may manifest its effects, modifying or aggravat-
 ing the symptoms existing; and that it is desirable to remove
 this element which  is mingled in the case.   This view, I can
 assure you, is correct, and one of great  practical importance.
 In many  of these diseases embracing the miasmatic  element,
 such removal of that element as antiperiodics are capable  of
 effecting, will very often greatly change the whole aspect of the
 case for the better, if it does not sweep away all diseased action
 together.
    This view includes the doctrine that more than one morbid
 cause may be present, and  producing effects upon the system at
 the same time, causing a mingling of diseases.  Of the  truth of
 this doctrine there can be no doubt; and, if this fact be not  kept
 in mind, you will in practice often  meet with cases defying diag-
 nosis,— at least,  you will  meet vith cases which you  will be
 totally unable to assign as exclusiv 3ly belonging to any nosolog-
 ical class.    Types of disease are constantly blending;  and  con-
 versions take place, by one element, comparatively dormant in
 one  stage  of a disease, obtaining the ascendency in  another.
 Indeed, the morbid results of one  disease may beget another of
 a different type; and thus, a disease having  a single  original
 cause may change its type in its course.  This is true of fevers,
 and of other forms  of  disease.  But I do  not propose to dwell
 upon these points; my object now being simply to impress the
 fact that  the  miasmatic poison does operate in connection  with 
Lectures on Sulphate  of Quinia.          23
other morbid causes, and that many diseases in malarial regions
present evidences more or less distinct of a miasmatic element
in their composition, requiring attention in treatment.
   I  should, perhaps, say in  this connection, that the malarial-
influence, even when sufficient to produce a controlling effect in
many respects over the character of a disease, does not neces-
sarily produce distinct  and  clearly perceptible  periodicity  in
symptoms, though such periodicity is usually present.  Indeed,
some malarial fevers  have  their periodicity  almost entirely
covered by the  local derangements or the severe general dis-
turbances quite speedily produced;  yet there is  always a ten-
dency to  periodicity, and^ under all ordinary circumstances it
may be distinctly traced.
   The particular diseases for which these remedies that I have
called,  following the present usage, Antiperiodics y but which,
with quite as much philosophical propriety, might be designated
as Antimiasmatics,  are most frequently prescribed,  are inter-
mittent and remittent fevers; and these may be regarded as the
types of miasmatic or malarial diseases.
   Into the pathology of these diseases I shall  not fully enter.
Whether the poison first  makes its impression upon the nerves,
the tissues of  the various organs, or  upon the blood, I shall not
attempt to decide.  That the blood  is in a morbid condition in
these fevers, there can be no doubt.   The ..material poison, if
there is one (and I have already expressed my decided  opinion
that there is—the facts in the case can not be accounted for  on
any other hypothesis), must enter the circulating fluid, and  be
carried by it to the tissues, nervous and others; and it is reason-
able to suppose, that it produces some changes in that fluid.   It
has been supposed to operate there in the manner of a ferment,
or to produce  successive cryptogamic crops, &c.  Of all this, we
know nothing; but, whether from the direct action of the poison
on the blood,  or from  its effect on the nerves and other organs
concerned in  the processes  of sanguification, the blood soon
becomes in a morbid state; and, in consequence of this, and the
impression made upon other organs,  the morbidj phenomena are 
24           Lectures on Sulphate  of Quinia.
produced.  There is a disturbance of the calorifacient process —
shivering comes on, during which congestion exists in the spleen
and  other internal organs:  this is followed by the hot stage,
presenting in a well-developed case all the usual phenomena of
a high grade  of fever, which, after a greater or  less length of
time, is succeeded by the sweating stage;  and when this has
passed by, a period of diminution, or more or less suspension, of
symptoms occurs, to be followed by a repetition of  the same
phenomena.   As this state of things  continues  on, the spleen,
the liver, and other organs become involved in various morbid
conditions and actions:  the spleen becomes  congested and en-
larged, sometimes inflamed;  the liver may be the subject of a
similar irritation, — its secretion becomes deranged, sometimes
increased and sometimes diminished;  the stomach is often con-
gested and irritated, its  coats may be inflamed, and its functions
are more or  less impaired; the kidneys are also involved;  and,
as in all fevers, the nutritive  processes, the formation and disin-
tegration of tissues, is  interfered with, the destructive far exceeds
the formative  processes, and  if the secreting organs do not per-
form more than their wonted labor, effete matter rapidly accu-
mulates in the system.   By these various processes, if not by
the  direct action of  the  malarial poison, the  blood becomes
deteriorated and unsuited  to its proper uses.   When the disease
has continued for a considerable length of time, decided anemia
is manifested, and especially if the spleen  be much affected.
The  co-existence of marked anemia, and structural changes of
that  organ, favors the opinion that its function is to manufacture
blood  ctrpuscles.   The diseased  conditions of the spleen and
other  organs, at  first the consequences  of a morbid agency,
become the  causes of other morbid actions; and thus a linked
chain of pathological associations results, which is interesting to
trace.
   This miasmatic  poison, when  abundant and intense,  may
operate upon the most vigorous and healthy system; but there
are various causes which predispose to its action.   Among those
most commonly enumerated, are exposures, fatigue,  improper 
Lectures on  Sulphate of Quinia.           25
food and drink, and all causes which exhaust the vital energies.
The deficiency of respiration which exists in the  rarified air of
hot climates and seasons, and, as a consequence, if the same diet
be taken, the retention in the system of carbonaceous materials,
there is reason to believe, acts as a predisposing cause; and the
deficiency of any of the  secretions — of  those of the liver, the
kidneys, or the skin—by retaining effete or decomposing matters
in the system, seems to favor the action of all zymotic poisons.
    Now, Gentlemen, if the general views respecting the pathol-
ogy of miasmatic diseases I have thus imperfectly presented be
correct, the indications of treatment — the particular things to
be accomplished, which I have so often told you must  be dis-
tinctly in the mind before a medicine is prescribed—the indica-
tions in these  cases are, first, to  remove  the poison or prevent
its action;  and, secondly, to remove or modify its effects.
    As effects  may become causes, and as the links in the  chain
of phenomena may be curiously arranged and united, the last
named indication may become the first for which efforts at fulfil-
ment are required.
    Though to remove the original morbid cause, or prevent its
action, would  seem to be the first thing demanded, yet you may
be called to a case at a stage  of its progress when some of the
effects of the  original morbid agents, themselves then operating
as causes of other serious results, require  your earliest attention;
and frequently, in removing or modifying some of these symp-
toms or effects, you  prepare the system  for the more safe and
efficient action of the remedy which will fulfil  the first indica-
tion,—that of neutralizing the miasmatic poison.
    As a general rule, in the  ordinary miasmatic fevers, at the
stage in which you will usually be called in, my experience has
taught me that to institute to some extent what is  called pre-
paratory treatment, before giving  a direct antiperiodic,  is on
the whole best.   Some  practitioners  commence  the treatment
ordinarily with an article designed  to operate as an  antidote to
the malaria, and, if necessary, to correct some of the conditions
produced  by this malaria  afterwards; and this mode in some 
26           Lectures  on Sulphate of Quinia.
cases, especially if commenced  at the very onset of the attack,
succeeds well.  Others are in  the  habit of combining with the
malarial antidote—administering them at the same time—some
articles designed to remedy those derangements of the functions
which the original  cause of the disease has produced; and in
other cases  this plan answers  a good purpose;  but, as already
stated, a majority of cases will be best managed by first correct-
ing some of the conditions present by other remedies, and after
such preparation to administer the  direct antiperiodic.
   Among  the  conditions  important  to  correct, are the  ob-
structed and deranged secretions, biliary, gastro-intestinal, cuta-
neous, and renal—thus often  relieving constipation, removing
foul  ingesta, depurating the blood of irritating and  offensive
materials, and diminishing the length of the paroxysms—the
intensity and force  of the febrile excitement.   Again, local con-
gestions, determinations, and inflammations, if they exist,  should
be abated  or removed—at least, it is often important, that
some effort, with this view, should be made before the anti-
periodic is  given.   Often in the early stages of a miasmatic dis-
ease  the fever  is  continuous;  an intermission, or at least  a
decided remission, should usually, though it need not always,
be  obtained.
    The means for accomplishing these purposes  are various, but
by the  principles already pointed out to you, they will readily
be suggested.  For correcting the biliary and gastro-intestinal
secretions, in ordinary cases, a mild mercurial, such as from four
to ten grains of Blue Mass, combined perhaps with a scruple of
Bicarbonate of Soda, and followed in a few hours by an  unirri-
       v     rtic,  such as one of the neutral salts or Castor Oil,
will be  found beneficial.   Should there be severe local  deter-
minations, such as to the  head, t&e abdominal  or the thoracic
viscera,  and sthemic  plethora be  present, the  greatest relief
would be afforded by a venesection.   If unaccompanied with
plethora, as is very generally the case, other  means will be
more appropriate,—such as revulsives and the milder sedatives.
Should the fever be very active and disposed to be continuous, 
Lectures  on Sulphate of Quinia.           27
cooling diaphoretic and diuretic drinks should be added to the
means already indicated.  Cold water to the head, and cool or
tepid water to the surface  generally, are very useful in most
cases; and should there be great irritability of the system, and
particularly of the stomach and bowels, and not very great de-
termination of blood to the head; and usually after a cathartic,
a full opiate — and the best form is Morphia—will procure the
greatest  relief, often  determining an intermission  of the fever
with  a free diaphoresis.  A brief period of management by
means of this kind—which  I do not propose here more fully
to specify—will prepare the way for the administration of the
antiperiodic,  rendering its action more efficient and safe.
   In many of your books, Emetics are recommended as proper
aud ordinary preparatory means.  There are undoubtedly cases,
as when an attack has occurred just after a hearty or injudicious
meal, where a dose of Ipecacuana or Sulphate of Zinc, or, what
would perhaps be better, free draughts of tepid water, and a
tickling of the throat to  excite emesis, would be  beneficial in
removing offending materials;  but any thing like the general
administration of emetics in our miasmatic fevers can not be too
decidedly or too strongly condemned.   On this subject, I  can
not be restrained in the expression of my opinion by any autho-
rity contained in the books;  and  especially so, as nearly, if not
quite all, of the enlightened Practitioners of the West will sus-
tain me in this position.  In all our fevers there is  more or less
tendency to gastric and intestinal irritability and irritation — a
condition very generally aggravated and developed by the ope-
ration of emetics.  In  my early practice in the West,  I used
frequently to see  the  patients  of  a neighboring physician who
followed the old practice of giving emetics, and, without respon-
sibility in the administration, often witnessed the effects of anti-
monial vomits.   Often have I seen patients prostrated as with
cholera, requiring the most efficient  measures to  prevent col-
lapse from hyperemesis  and  hypercatharsis; and when relieved
of this peril, an obstinate gastric inflammation was apt to follow.
But it was written in the books, that  emetics must  be given in 
28           Lectures  on Sulphate  of Quinia.

"bilious fevers" — the  stomach must be cleansed; and  what
would do it so effectually as Tartar  Emetic?
   Drastic purgatives should receive the same unequivocal con-
demnation.  At a somewhat  later period, I knew another Prac-
titioner of considerable note, who used, as a common prescription
in fevers of this class, what he  called  his " Thunder and Light-
ning  Pills."   They were composed, I believe, of Calomel,
Gamboge, Scammony, and company — I am  not sure  of  what
precisely; but  they nearly tore the intestines out of people, I
have been told by some who have tried them, and they certainly
often produced the greatest irritation and prostration, followed
by gastric and intestinal inflammation.   Treatment of this  kind
often converts a simple  intermittent fever, which should be re-
moved in three days, into a continued, protracted, intestinal
fever, which endangers or destroys the life of the patient. When
speaking of emetics and cathartics I shall have occasion to  refer
to this subject again, and shall hope  to make such an impression
on your minds as shall save you.and your future patients  from
great errors, and their results, in this direction.
   By the means which I have only hinted at, as it were, you
will, in a very few days, in all ordinary miasmatic fevers, obtain
a distinct intermission or a very decided remission of the febrile
symptoms; and then, after these gentle  evacuations, is the time
to administer your antiperiodic.  As a general rule, it is best to
wait for  an intermission, or  at least a well marked remission,
before the antiperiodic is given; but if the  case be malignant—
if there be severe congestion or depression, at the risk, if there
be any, of doing harm  with an antiperiodic,  it must be given
without delay.  Different antiperiodic articles operate in some-
what different modes in accomplishing this purpose.  What is
known respecting the action of Quinine in these cases, I wilP in
the next Lecture proceed  to discuss.   I will simply add here,
that after the periodicity is broken up,  all the consequences of
the disease left behind  should receive attention.  You should
seek to restore a natural condition  to all the organs and  func-
tions of the system. 
LECTURE III.
Gentlemen:
     In yesterday's Lecture, we took a brief view of Periodical
or Miasmatic Diseases, and of the class of Antiperiodic or Anti-
miasmatic Medicines;  and, by  the review just had, I perceive
you have not been inattentive  to the subject.  This view was
necessary to be taken, in  order to render intelligible what I
have to say  on the most important therapeutical applications of
Quinine; for it is as an Antiperiodic that this article manifests
its most wonderful and most beneficial effects.
    The mode in which Quinine produces these effects as an
antiperiodic — the  particular  manner in which it  operates,
whether by restoring some wanting material in the blood or the
system, or by neutralizing  a poison there, or by so impressing
the organism, particularly the nervous system, as to prevent the
poison of malaria from producing its effects—we do not  posi-
tively know; but  probably  (may we not  say certainly?) it
operates in one, two, or all three of these ways.  There is no
absurdity in believing that it  operates in  all.  If so, it would
be, according to the  classification  adopted, founded upon the
 modus operandi of medicines,  a Restorative Haematic, a Cata-
 lytic Hwmatic, and a Neurotic.
     I have,  in the former Lecture, referred to some of the facts
 indicating that miasmatic fevers are blood diseases —at least in
 part; and  if so, the  remedy  which  more effectually  and cer-
 tainly than any other removes  those fevers, we might plausibly
 infer operates as an haematic—operates in and upon the blood.
     Liebig, in his Animal  Chemistry, states, that certain bitter
 vegetable substances  are  very analogous in composition to a 
30           Lectures on Sulphate  of Quinia.
certain neutral principle called taurine, existing in the bile.  He
has shown that, to a large extent, the elements of the bile, after
being poured into the intestines, and  after  performing their
office there, are re-absorbed and taken again into the system—
little else than the coloring matter of this secretion being really
excrementitious.  He found that if  bile was  injected  into the
rectum, it was absorbed  from that viscus, and that  it did not
pass out into the urine.   He infers from these facts, that these
absorbed elements are appropriated by the system, and are use-
ful and  necessary to its integrity; that  when the bile-secreting
function of the liver is so deranged that the necessary amount
of the main bile-principle, taurine, is  not elaborated,  unpleasant
symptoms  are the consequences,  and the  place  of the taurine
must be supplied, either in kind  or  by  a substitute.  His idea
would seem to be, though he does not  quite clearly express  it
so,  that when  the liver does not properly act, some  of the
elements out of which bile is  formed remain in  the blood in a
form to  do mischief, and that some other elements  or com-
pounds which  the liver is alone capable of forming,  and which
are required in the system, are, by this deficient action of the
liver, absent;  and  when  this deficiency exists,  particularly  of
taurine, the vegetable bitters, and particularly Quinine and its
analogues,  are indicated,  under the  idea that they are similar
substances, and will supply its place.
   Headland  adopts  this view  as  probable, and  points out
analogies between taurine and the bitter vegetable  principles.
They are both  bitter to  the  taste, are  composed  of the  same
ultimate elements,—the taurine possessing a little more oxygen
than the bitters;  but oxygen is always  readily supplied in the
system.   The ox-gall, when there  is a deficiency of bile, operates
as a general  tonic, and, it is thought by some,  produces  more
tonic effect than  can be  accounted for  by its action upon the
alimentary canal  and the process of digestion simply.   From
these analogies, and other observed facts respecting  the action
of Quinine in  moderate doses in  health, Headland draws the
conclusion that this article is not  unnatural to the blood, or at 
Lectures  on Sulphate of Quinia.           31
least that it may exist  there in moderate quantities in health
without detriment, and that in such moderate quantities it is
retained in  the blood and appropriated by the system:  and in
disease, he  concludes, that when there is a  deficiency  of the
bile element it acts a,,as restorative haematic.   If these views be
admitted, they will assist in  accounting for the improvement in
those processes of secretion and ultimate nutrition, which, in
the estimation of the competent authority (Dr.  Pitcher) re-
ferred to in the first Lecture  on this  subject, is produced in
tuberculosis and other similar diseases  by the long and  contin-
uous  use  of Quinine in  doses of a few grains per day.
   That it  may act as a restorative haematic in many cases of
miasmatic disease, I  see at least no reason to deny, but rather
reasons for supposing probable; especially when it is considered
that in these diseases there may be a deficiency of some element,
which, if present in proper quantities, would prevent the action
of the miasmatic poison.   Certain it is, that all persons exposed
to the malarious influence are  not attacked with malarious dis-
eases, and possibly only those are affected whose systems are
rendered susceptible by the  absence of these  bitter compounds.
   But still, if these fevers are produced, as I believe they are,
by a  poison in  the blood, it would seem most likely—at least
very reasonable—that the article of medicine which arrests the
action of that poison most  speedily, does so by operating di-
rectly upon it, neutralizing its poisonous qualities.  From this
consideration,  I would infer its catalytic effect; that is, that  it
operates  by destroying  a deleterious  material, or arresting a
morbid process in the blood, especially  in acute cases, and when
acting as an antiperiodic in contra-distinction  from its action as
a  tonic.  This view  is  strengthened — at least  the  exclusive
restorative  hypothesis seems disproved—by  the fact,  that in
violent cases of miasmatic fever, Quinine must be given in order
to produce  prompt effects, in quantities larger than are retained
in the blood—to  such  an amount as  that it freely appears in
the urine.  Arsenic,  which often breaks up agues almost as
promptly, and some  think more permanently, than Quinine, no 
32           Lectures on  Sulphate of Quinia. '
one will regard as supplying  directly any needed element to
the blood and  the system; and from the slight apparent effect
upon the nervous system which even very efficient anti-periodic
doses of this metallic oxide produce, we conclude that it oper-
ates as a catalytic,— as a neutralizer  of the poison.  Is  it not
reasonable to suppose,  then, that Quinine operates in the same
way?
   But Quinine impresses strongly the nervous  system,  and
may produce its effects—in my judgment it does, in part, at
least—by exciting a new action  in  the  system incompatible
with the malarious fever action, producing what has sometimes
been called a constitutional counter-irritation, or cure by substi-
tution  or supercedence.  In other words, the impression made
upon the nervous system by the medicine supplants, or prevents,
the action of the poison or morbid cause.  The nerves are so
occupied and impressed, that they do not respond, in their pe-
culiar morbid actions, to the irritation  of the morbid agent.
   Now, neither of these three modes of operation is irrational,
and they are by no means  incompatible with each  other.  It is
an error to suppose that a medicinal agent must produce all its
effects by a single mode.  This is a limited, a partial, and an
untruthful view.   Most medicines operate in  more than  one
way—operate often upon distinct and different principles, illus-
trations of which truth I have frequently given you; and there
is no reason for saying  that Quinine is not one of these articles.
It operates,  not unlikely, in all the different modes indicated —
all tending to produce  the desired results.
    It has such a striking  effect upon the condition of the en-
larged spleen, in intermittent fever, as to have led Piorrt and
others to suppose  that it operates specifically upon that  organ,
and, in some way, by this means cures the fever.  Whether or
not it does thus act directly on the spleen, in  reducing its di-
mensions, is not fully  established.  To  make it appear that it
cures the ague in  this way, it would be necessary to show that
congestion and enlargement of the spleen are necessary condi-
tions in the causation of the disease.  The enlarged spleen is a 
Lectures on Sulphate of Quinia.           33
common consequence of the action of the  miasm, rather than a
cause of the febrile phenomena, and it is  doubtless diminished
in size because this poison is neutralized and  its resulting phe-
nomena are arrested.   It may be urged that enlarged spleens
are diminished in cases  where  the  ordinary phenomena of a
miasmatic fever are not manifest; and this is true:  but a mias-
matic influence may be operating upon the system  in the pro-
duction of morbid  conditions,  without there being a full de-
velopment  of febrile  symptoms.  Indeed, in  many of these
obscured,  and  partially suppressed,  malarial diseases,  internal
organs suffer more profoundly,  the blood  is deteriorated more
completely, and the vital energies are  exhausted more rapidly,
than in open, well-developed cases.   It is  prolyble  that in the
ordinary phenomena of a regular paroxysm  an effort  is made
to resist the poison, and that particularly in the sweating stage
a poison is  eliminated from the blood.  That in this  stage, some
morbid, or at least unusual, material is thrown off  by  the skin
is perceptible  to any one  having  ordinary olfactories;—the
"ague odor" is characteristic  and  well known.   Quinine op-
erates with as much curative power upon these masked, as upon
the more open, forms of malarial disease, and by removing the
cause suspends the consequences, among which is enlargement
of the spleen;  still, it is not impossible that Quinine operates in
a more direct manner in diminishing enlargement of the spleen,
and I must say that I have seen some of these enlarged organs
diminished by this remedy where there was no other evidence
of an existing miasmatic influence present.  With  me,  the
direct action of Quinine upon  the spleen, in reducing its en-
largement,  is an open  question;—Prof. Wood  does not admit
it.  There is, however, no sufficient evidence to believe that by
its acting upon the spleen miasmatic fevers are cured.
   As an antiperiodic,  Quinine is indicated in  all diseases where
other articles  o"f this  class maybe given—that is,  where the
disease  is  miasmatic in its origin, as indicated not only  by peri-
odicity, but by all the  other symptoms and circumstances; and
it is also indicated where the miasmatic element is present in
         c 
34           Lectures on  Sulphate of Quinia.
 the  course of other diseases modifying their characters.  This
 is the very general rule; and the exceptions  are in those cases
 only, where, under some peculiar circumstances of disease or
 idiosyncrasy, the Quinine is found by experience  to  be objec-
 tionable, or to disagree.   Where the miasmatic influence exists
 and  is a prominent feature, the  Quinine very seldom  does mis-
 chief, notwithstanding  inflammation  be  present,  provided  its
 use  is judiciously managed.  Its ordinary  effects  are believed
 to be modified by the presence of malaria.   Serious  lesions,
 such as  active congestion or inflammation of  the brain, and
 some cases  of  inflammation of the mucous membrane  of the
 stomach, contra-indicate its use  more than other conditions of
 congestion or inflammation.
   The combination of Morphine with the  Quinine  will gen-
 erally prevent its irritating the  stomach  in these  cases, but if
 great fears be entertained that the Morphine will not, the Qui-
 nine may be administered per rectum, or endermically,  with
 safety and success.   Morphine in free doses,  combined with it,
 will  very commonly so far allay the irritation and blunt the
 sensibility of the inflamed stomach as to prevent its responding
 to such irritating qualities as the Quinine possesses;  and,  in
 most cases of these fevers complicated with  gastric inflamma-
 tion, even if the latter should be temporarily increased  by the
 medicine, if the malarial  influence be overcome and the par-
 oxysms of fever  be arrested, the local difficulty will readily
 subside.  And  it is seldom that a quantity of Quinine neces-
 sary  to break up the fever, if properly guarded by Morphine,
 will  produce as much irritation of the stomach, or in  fact any
 part  of the system, as a paroxysm or the return of  fever would
 do.  Indeed, in some cases, the stomach even,  so far from being
irritated, seems soothed by Quinine.
   Though Morphine is so efficient in modifying and preventing
the irritating effects of Quinine on the inflamed mucous mem-
brane of the stomach, and most other parts of the body,  it does
not usually prevent, but often rather  increases its tendency to
injurious effects in active congestions  and inflammations of the 
Lectures on Sulphate  of Quinia.           35
 brain complicating  miasmatic fevers.  But, in all these cases,
 the question will arise, Whether more mischief will be done to
 the brain by the Quinine than by the continuance of the fever
 which the Quinine will  arrest ?  In complications of this kind,
 where the  stomach and  bowels are  not inflamed, Arsenic may
 be given as an antiperiodic, as this is not likely to irritate the
 encephalon; but, if a complication of fever with inflammation
 of stomach  and  brain occur,  I would risk the Quinine rather
 than the Arsenic.  Give the Quinine in these, and indeed in all
 other, cases of miasmatic fever, especially if acute, in free  and
 decided antiperiodic doses during one intermission,  apply cold
 water to the head, and use, perhaps, revulsive measures;—use,
 I repeat, the  Quinine in sufficient quantity  during  one inter-
 mission to  break up the  fever,  and, then,  if there be  local
 irritation especially, have done with it.  Knowing the importance
 of this principle, and how  frequently  it is violated,  I  can not
 express it, and impress it upon you, too strongly.  Where there
 is danger of producing irritation with Quinine, do not protract
 its effects;  where Quinine  is given for antiperiodic purposes in
 cases complicated with inflammation, give it  in sedative doses.
    The  doses of Quinine,  as has already been stated, which
 produce sedative effects, are free doses, from five to ten or more
 grains—from a scruple to  half a drachm in a few hours.  The
 quantity usually necessary to break up a miasmatic fever is one
 Bcruple—often less will do, seldom more is necessary; and this
 quantity is usually best given in four doses, and always during
 one intermission.
    In intermittent fevers complicated with other inflammations
 than of the stomach and the brain, the Quinine seems generally
 to do good  to the inflammation as  well as  the  fever element—it
 often sweeps away the  whole together.   Its administration
 should be preceded by attention'to the secretions—perhaps by
 the use of means to directly reduce the force of the inflamma-
tion ; Morphine should generally be combined with it to render
its action more sedative; and  then, by giving it in full doses,
the work of cure is often accomplished. 
36           Lectures  on Sulphate of Quinia.

   I have been supposing cases of miasmatic fever complicated
with inflammation and  active congestion; and these cases not
very unfrequently, in some localities and seasons, occur.  But
by far the greater number  of these fevers have  no genuine
inflammatory complications, and the congestions are often of a
passive rather than an active character.  Conditions  of decided
general and local irritation are more frequently present, being
very active when the paroxysm is on, and subsiding with its
abatement.  Even when a local inflammatory process is devel-
oped,—when stasis and effusions, the more essential conditions
of this process, have  occurred, the nervous and vascular irrita-
bility is, proportionably  to  other phenomena, more intense, and
fluctuates with the conditions  of the fevers.   It  is a kind  of
inflammatory action so connected with, and dependent upon the
essential fever, that the  most effectual means for controlling the
inflammation is to remove the fever.   It is bad practice to allow
the fever to continue  until the local inflammation is subdued;
often, the local inflammation can not be subdued until the fever
is arrested.  If there  be plethora, there may be a  necessity for
resorting to depletion; but if the lancet be used, Quinine should
speedily follow it.  A mild alterative and saline purgative or
two will usually be required, but the Quinine should not be long
delayed; and in  all these  inflammatory complications,  except,
perhaps, where the local seat is the brain, the opiate should be
combined with  the antiperiodic.  This may not be  the teaching
in all your books, but it  is the true teaching, nevertheless.  You
must not  forget  that in  free  doses  Quinine  is capable of a
decided sedative effect;  and  that, even independently of its
anti-miasmatic  powers,  by its  relaxing and  diaphoretic  and
other peculiar actions  upon the nervous and vascular systems, it
is capable of controlling inflammations of a certain character
and grade, and especially such inflammations as occur when a
miasmatic poison  impresses the  system.  Still, when given long,
it is capalAe of  producing irritation, and particularly  of the
brain and the stomach.  It should not, then, be long continued,
lest this irritation  be  induced.  Its antiperiodic  effects are 
Lectures on Sulphate  of Quinia.           37
speedily obtained, and for this purpose it need not be protracted.
And particularly let me warn you against giving this medicine,
in acute cases of high excitement, in small, repeated, and long-
continued  doses.  I have known  many Practitioners to give in
cases where they were doubtful whether the Quinine would be
borne, small doses, such as a grain, more or less, once in a few
hours.  These doubtful cases, in consequence of imperfect inter-
missions, or of high febrile or inflammatory excitement, are the
very cases in which, if any at all be used, larger doses must be
boldly given; if the doses be insufficient to act as  a  sedative,
and not large enough to interrupt the  paroxysms of fever, you
will get an irritating  effect  of the Quinine combined  with the
irritation  of the  unbroken fever, and your patient  is made
worse.  Give it freely, or not at all—give  a full antiperiodic
quantity, or none.
    In my  notes, I have it written, " Impress  this."   I hardly
know how to do this, otherwise than by reminding you .of the
actions of Quinine already stated,—that in small  doses it acts
as an excitant, but in  large  doses as a sedative—of a peculiar
kind to be  sure, but yet  a sedative  to  many of the functions;
that free doses are necessary to produce a prompt antiperiodic
effect; and that these cases require promptness in their arrest,
and the avoidance of excitation.   I might cite cases for illustra-
tion,  but  I must  be contented with assuring you  that these
principles, supported by reason, were deduced from observations,
and have  been verified by abundant experience.   These are
not notions peculiar to myself, though, with some aids to be
sure, I wrought them out long ago at the  bed-side of the sick.
They are  fast coming to be  the views of the more enlightened
of the Profession who have had large experience in this class of
diseases.
    I have  already spoken several times of the combination of
opiates with Quinine in these fevers having inflammatory com-
plications.  The opiate also should be given  in decided doses,
ranging from  one-sixth to one-half a grain or more of the Sul-
phate of Morphine, given with from four to eight  grains of the 
38           Lectures on Sulphate  of Quinia.
, Quinine, once in from two to three or four hours, taking care to
 have administered the requisite scruple or more of  Quinine
 during one intermission, and as much  of the Morphine as may
 be taken without too much narcotism.
    There are other cases than the inflammatory complications
 requiring the addition of  Morphine.   Whenever there is irrita-
 bility  of  the general vascular system,  and especially  of  the
 nervous system, it is  indicated.  Opium, indeed, has some anti-
 periodic powers, and it very generally  enables the Quinine to
 be better borne.   When gastric or  intestinal irritations  are
 present—when vomiting  or  diarrhoea manifest themselves, aa
 they not  unfrequently  do,—I  need  scarcely say the opiate is
 specially demanded.  When the skin is rather dry, and the in«
 termission is not perfect, a  full dose of the Quinine and Mor-
 phine will often produce the  most abundant sweating, and with
 proper repetitions, the crisis will be past.  When the secretion
 of the liver is  markedly  deficient, Mercury,  with advantage,
 may be joined with the Quinine.  When the skin  is dry, and
 husky, and the stomach is not too irritable, diaphoretics  may be
 given at the same time with Quinine.
    In some cases of diarrhoea, Tannin may be added.  It nearly
 destroys the bitterness without impairing the virtues of Quinine,
 adding the quality of  astringency to the  combination.  The
 Tannate of Quinine  is an officinal preparation, combining to a
 large extent the qualities of both the Quinine and Tannic Acid.
 It is used instead of the Sulphate in  cases accompanied with
 much relaxation and  profuse secretions  and discharges—such
 as where  there is excessive sweating and passive diarrhoea.
    Various other combinations may be required in complicated
or peculiar cases; as, where there is much depression, stimulants
 will be needed — where there  is much irritability, and Opium
 can not be borne, other narcotics or nervines may be substituted
&c.  But  Quinine  is regarded  as having curative relations to
various other diseases than those which are malarial; and in the
next Lecture, after discussing  in a general way some of these
relations, I propose to point out somewhat more particularly the 
Lectures on  Sulphate of Quinia.           39
mode of using it in several varieties of paludal fevers and other
special diseases.   In  pursuing  this course, some of the ideas
already advanced may be repeated, but in different connections
and in more directly practical points of view.   But, Gentlemen,
in medical as in moral  teaching, "fine upon line, and precept
upon precept" are necessary  to  embed important facts and
principles deeply and  fixedly in the mind. 
LECTURE IV
Gentlemen:
     In this Lecture (which will conclude what I have to say on
the subject of Quinine, as intimated before we  last parted), I
propose to consider the relations of this article to some diseases
not considered malarial, and then to speak somewhat more par-
ticularly of the varieties of miasmatic fevers, and of the practical
application of this great remedy to their different forms.
   A few years ago, Dr. Dundas, of Liverpool, recommended
strongly Quinine in free doses in continued fevers, typhoid and
typhus, with a view of cutting short the progress of  these dis-
eases.  His testimony is to the effect, that in a large majority of
cases it will speedily break these fevers up. This announcement
from what was regarded as respectable authority, arrested fully
the attention of the Profession, and many trials have been made
to test  the correctness of the statements. I have given this treat-
ment a trial in my own person, and have also tried it and seen
it tried in many other cases, and therefore have a right to the
expression  of an  opinion.  I  must assure you  that respecting
this  matter there is some mistake.  As already intimated, dif-
ferent  forms of fever may be  blended in  the same case.  Two
or more poisons may operate upon the same system at the same
time.  A fever, the  result of  a malarial and of  another poison
combined, maybe "continued" in its character—indeed, a pure
malarial fever is  not necessarily so decidedly paroxysmal as to 
Lectures on Sulphate of  Quinia.           41
be regarded as "intermittent" or "remittent."  It is, therefore,
sometimes difficult to distinguish a fever, malarial in its course,
from  one originating in some other poison  or morbid agenoy.
Mistakes in diagnosis may easily occur.   Dr. Dundas's cases of
fever  reported as "jugulated" by Quinine may have been partly
or wholly malarial.   I  believe they were.  According to my
own observation, and that  of all the medical gentlemen with
whom I am acquainted and have conversed on the subject, Qui-
nine  does not  control, in the way of "breaking up,"  a  pure
typhoid or typhus fever.  When a miasmatic or malarial influ-
ence exists and prevails, that element, and often the whole dis-
ease,  will be controlled  by Quinine.  I have often seen cases of
continued fever, but marked by regular paroxysms  of great
exacerbations, have the  paroxysmal character removed by anti-
periodic doses of Quinine — the  appearance  of the fever being
materially changed, but continuing, nevertheless,  in the regular
form  and course of a typhoid fever.  Other cases,  even  less
paroxysmal, are sometimes  entirely broken  up by this remedy,
it is true, but these cases I have regarded as  malarial in their
origin. Quinine in antiperiodic doses does not usually materially
injure a patient in a case of pure typhoid fever.  As a practical
matter, in doubtful cases, if the brain  is not too much  con-
gested, Quinine may be tried in full doses for a short time.  The
character of the fever, by this process, will be tested.
   The real use of Quinine in typhus  and typhoid fever, is in
smaller but continuous doses, with a view of sustaining the sys-
tem under the depressing influence of those diseases.   Used in
this manner, it  is often very useful, and should  generally be
combined with small doses of Opium,  especially where there
are intestinal lesions.  It must, however, be acknowledged, that
in  some conditions  of the  system, Quinine  seems to  exert an
immediate and  direct,  though  transient, febrifuge influence,
independent of its malaria-destroying, or antiperiodic  qualities.
   The term febrifuge, used in its literal sense, means a remedy
capable of driving away a fever.  As now used, I mean  by it a
medicine which directly removes or mitigates febrile symptoms, 
42           Lectures on Sulphate of Quinia*
 such  as  increased heat, excitement of pulse, &c.  Now, the
 sedative  and diaphoretic powers of large doses of Quinine ena-
 ble it, in some  cases,  to  ultimately abate  the heat, <fcc, when
 given during their presence.  But such  effects, in the absence
 of a malarious cause, are temporary, and it should  seldom be
 prescribed for such  a purpose.  There is danger of doing mis-
,chief to the brain if sedative doses are continued long, and there
 are other articles which, for  this purpose, are more effectual
 and safe.
    The late Dr. Harrison, of Ohio, while  acknowledging this
 direct febrifuge influence of Quinine, thought it could scarcely
 be attributed to its sedative action; "but that, by a sudden and
 powerful impression upon the nervous system, it creates a substi-
 tuted action for the febrile disturbance, and this, aided by its
 diaphoretic  tendency, subverts the catenated train, or procession
 of phenomena, which constitutes  fever."   He regarded it as
 acting, as you will perceive, by the method of substitution, or
 as a supercedent.  However this particular point may be (and
 I do not see why this explanation will not apply to many other
 articles regarded  as sedatives), Quinine  often exerts a direct
 febrifuge influence of this  kind, when given in free doses; and
 this effect is increased by combining it with Morphine.
    When, therefore, there is a strong and  clear indication for
 an  antiperiodic, in  consequence  of a malarial element being
 present,  you need not  be prevented from  using the Quinine,
 though you may not  be able to get an intermission of the fever,
 or may not  subdue all inflammatory action.   Indeed, as already
 intimated, certain  forms of inflammations, particularly those of a
 congestive character, are diminished and controlled by Quinine,
 especially when Opium or Morphine is combined.  You may uot
 have  received these ideas from your books, but yet they are
 true.   However inconsistent with pre-conceived notions, or how-
 ever  apparently so with any other statements that  may have
 been made  about Quinine, it  has  under  many circumstances a
 tendency to equalize the circulation and remove congestion, and
 often, too, in an eminent degree. 
Lectures on Sulphate  of Quinia.          43
  In cases of the severer  congestive forms of malarial or other
fevers, its immediate tendency is usually to relieve that conges-
tion;  and, further, while it exerts, in some respects, a sedative
influence—while it may diminish the pulse and relax the surface,
—it, at the same time, so impresses some of the organic func-
tions  as to  sustain, when in  danger of suspension, the powers
of life.  In  these alarming depressions, usually regarded as vio-
lent congestions, when the nervous  system has received a deep
benumbing  shock, and  lies prostrate beneath  the power of the
disease, this remedy seems to release the innervation frcm its
oppressed condition, and  awakens a degree  of re-action, which
Sometimes  is developed  into  a degree  of open fever  much
preferable to the previous depressed condition; or, what is more
likely and still better, at once cuts  short the catenated train of
symptoms—relieving the  oppression, removing the congestion,
and preventing  further fever.  Patients in these most alarming
conditions are often speedily restored to comparative safety and
a state of convalescence by the free use  of this glorious med-
icine.
    You will pardon a little warmth of expression on this subject
in one who has served a long campaign in combating the mala-
rial diseases of the West,  and who has almost  never  found  this
article disappointing his hopes.   Why, Gentlemen, without Qui-
nine, or some similar article, the material and social development
of this whole region must have been retarded for at least half a
century, if, indeed, it had not been prevented altogether. What
would Ohio, or Indiana, or Illinois,  or Wisconsin, or  the young
Iowa, or Michigan have been at this day, had not their early
settlers who cleared up their forests and broke up their prairies,
established their institutions, and laid the foundation  for their
large  prosperity, been  protected from the "pestilence which
walketh in darkness and destroyeth at noon-day," by this agent
of power?  Where would have been our Agriculture and our
Commerce? where would have been this Granary of so large a
portion of the world, literally feeding from its overflowing ful-
ness the  people of  the East?  where would  have  been  our 
44
Lectures on  Sulphate of Quinia,
Churches and our Institutions of Learning? where would have
been our own noble System of Free-Education, the peculiar
honor and  glory  of our State? where would have been  our
Common, our Union, and our Normal Schools?  and to crown
all, as the culmination  of all, where would have been our Uni-
versity,  with its  various departments,  attracting to its halls
young men of energy and  merit from nearly all the States of
the Union?—had it not been  for this, as the chief instrument
in the hands of  the  Physician, standing as he did  like an
angel with  a flaming sword, guarding,  in the  early and  the
subsequent inhabitants, the citadel  and fountain of health and
life?  It  may, at  first view,  seem  extravagant to attribute
so much to an article, extracted from a foreign bark in a chem-
ist's laboratory, and kept in  small bottles on a druggist's shelves;
but all who know the facts,  and have reflected upon the subject,
will  acknowledge the literal truth of what I have said.  But
this is a digression,  though  one  perhaps justifiable, especially in
these times when  it has become too much the custom to dispar-
age the Physician and the agents he wields.
  I was saying that Quinine often equalized the  circulation,
removing congestions, and controlling to a decided extent various
congestive  inflammations.   In accordance with these principles,
it is found  useful  in cases of Erysipelas of a sub-acute and con-
gestive character—in many of the  cases of epidemic erysipelas,
and  especially where there  is  a tendency to  gangrene or free
suppuration.  The doses here should not  always, or even gene-
rally, be of a  sedative  character,  but tonic rather; and other
preparations of the Bark where the cases became protracted
may be  preferred.
  The Muriated Tincture of Iron I shall speak of hereafter, and
of its striking effects as a remedy in this disease.
   Quinine is often very useful  in erysipelatous and suppurative
and  gangrenous inflammation, arising in connection with trun-
matic injuries.  In these cases, it should be given in tonic rather
than sedative doses, and in connection with a good  diet  and
sometimes  with stimulants. 
Lectures on Sulphate of  Quinia.           45
   Quinine is an important article  of treatment in some cases
of Pneumonia — especially those occurring in malarial districts
and assuming a low, or what is sometimes called a typhoid form.
Where much periodicity is manifest, and the malarial influence
is still active, antiperiodic doses will be required.   Where Qui-
nine is used in the more acute cases, its sedative  effects for a
time must be obtained; but in the slower and more protracted
oases, it may be given with much  advantage in smaller doses,
continued for days, and sometimes weeks together.   My friend,
Dr. Pitcher, to whom I have already more than once referred, is
very partial to the use of Quinine in doses of about two grains,
two, three, or four times a day,  in slow pneumonias and  bron-
cho-pneumonias, with more or less pulmonary effusions, or exu-
dations, so apt to follow malarial and typhoid fevers.  I have
witnessed several excellent recoveries in such cases, by the use
of this article in his hands.
    Many cases of Diptheritic  Inflammation,  including the
lower grades, especially, of Membranous Croup, are believed
to be much under the control of free doses of Quinine.   Indeed,
Very many of the inflammations of the mucous membranes, not-
withstanding Quinine  sometimes irritates the gastric  surface,
are favorably affected by it.  I shall have occasion  hereafter to
speak more particularly of croup, as»it belongs to the "Diseases
of Children," and will then point out the circumstances in which
I regard Quinine as useful, and detail the manner of its applica-
tion.  I shall then tell you that croup is often markedly periodi-
cal in its symptoms, suggesting by this fact and others the  use of
Quinine.
    Many cases of Dysentery, Gentlemen, are dependent upon
malarious causes, and present marked periodicity in their  symp-
toms and their course.  When the liver is congested, as it often
is when a malarious influence is present, the portal circulation
is of course obstructed—the blood does not freely return from
the parts supplied by that system of vessels, and congestion and
inflammation of the other abdominal organs are apt to  occur.
Dysentery from this, and perhaps other influences of the malar 
 46           Lectures on Sulphate of Quinia.

 rial poison is no unfrequent result.  If a developed malarial fever
 be combined with dysentery, during each paroxysm of the fever
 the symptoms are greatly enhanced; and I need hardly say that
 in all such cases the leading indication is to arrest the paroxys-
 mal fever.  Of course Quinine is the remedy; and, during its
 operation in antiperiodic quantities, it does not enhance, but, if
 combined with Opium it particularly diminishes, the dysenteric
 irritation.   Other means proper to dysentery must not be neg-r
 lected, but  they will usually be  applied to little purpose while
 the paroxysmal fever continues.  The  great utility of Quinine
 in  these cases  is beyond what I have  time or even power to
 express.   I might relate many cases taken from -the very jaws
 of death by the use  of Quinine; some of them now in my mind
 having been nearly  sacrificed to the delusion of Homoeopathy.
    These remarks  made respecting dysentery will apply to a
 greater or  less extent to Diarrhoeas, Enteritis,  and  Cholera
 Infantum.  I need not here speak particularly of these cases.
 They are often connected with  a malarious influence and present
 marked periodicity  of symptoms, and in all such cases antiperi*
 odic doses of Quinine  can not properly be withheld.  Some of
 these cases not  markedly periodical will, nevertheless, yield
 promptly to Quinine.  In a case occurring in a malarious region
not yielding readily to other treatment, whether distinctly peri,
odical in symptoms  or not, I should regard myself as not having
done  my whole duty until I had tried the efficacy of this remedy.
In all these cases, it should  be  given—as  when the design is to
break up a fever,—in full antiperiodic  doses, and  then be. susr
pended.  It must be borne in mind that large doses of Quinine
long continued are capable of producing irritation and mischief,
particularly of the  brain.   One or  a  few impressions  of the
article seldom do much injury,  whereas many may.   This is not
peculiar to Quinine. One or a few fits of alcoholic intoxication
will not produce delirium  tremens, but  the  protracted  use of
alcohol — many fits  of intoxication—often will  produce  this
disease.   Because Quinine is innocent in  large doses when its
impression is continued for a few hours, we can not infer that it 
Lectures on Sulphate  of Quinia.          47
may be used in like manner for  as many days, with the same
freedom from injurious results.  A good general rule is, though
doubtless  subject to some exceptions, that  short work must be
made with large doses of Quinine.
   Of the use of Quinine in Asiatic Cholera, I have some words
to say.  On this subject I speak from an experience by no means
limited, and my views are very firmly fixed.  I regard Quinine
in this terrific disease, as it generally presents itself, as a very
important remedy; and in the form this pestilence as it prevails
in some seasons and  localities, the use of Quinine is an essential
part of any thing approaching successful treatment.
   Now, Gentlemen, I wish to express to  you  my strong con-
viction, that cholera, so generally fatal when left to itself, and
in some of its forms so apt to  be  fatal under any management,
is still much more under the control of proper remedies skillfully
applied than the general literature  of  the Profession  on t\§
subject would lead you to suppose.  I shall not here enter upon
its pathology, and shall say but little of its general therapeutics.
I will speak more of its treatment when upon the subject of
Opium; for after all that has  been justly said against the too
free  and the injudicious use of Opium, it is the most important
remedy in the management of the disease.  But Quinine has its
important  uses, and  of these I shall  briefly speak in this con-
nection.
   There  are two leading objects in cholera for which it may
be given—two distinct indications which it may fulfil.  In what
has been called the congestive stage of the disease,'—when the
blueness has come on, the respiration having been diminished,
the capillary circulation, perhaps by spasm of the smaller vessels
having been obstructed, and the patient from loss of the fluid por-
tions of the blood, from deficient aeration of that which remains,
and probably from a more direct depressing effect of the cholera
poison upon the nervous system, is ready to sink  from perver-
sion  and suspension of the organic functions — Quinine in doses
of three, four, or six grains, often best combined with such stim-
ulants as Ammonia and Mustard,  repeated  once  in an hour or 
48
Lectures on Sulphate of Quinia.
two, will so modify the organic actions as while spasm is relieved
and congestion is removed, the vital energies will be sustained.
In cases of this kind I am supposing that the discharges have
been restrained or checked by Opium, Camphor, and astringents,
and that an effort has been made to excite the biliary secretion
by appropriate doses of a Mercurial;  and if much narcotism has
been induced by the Opium necessary to arrest the discharges,
the Quinine, aided by as free doses as can  be borne of Coffee
or Tea, will relieve  this narcotism  and tend to  prevent the
suspension of the vital functions.   The nice  point in the  man-
agement of cholera is to administer Opium  in the active stage,
so as to allay the irritation of the  gastro-intestinal membrane,
and control the profuse and rapidly-exhausting serous discharges,
and at the same time not to produce such a degree of narcotism
as shall operate to diminish, to a dangerous extent, the process
pf respiration  and the aeration of the blood.  The irritation
must  be allayed and the profuse  discharges  arrested, or in a
majority of cases  death is inevitable.  No  article can be com-
pared with Opium in accomplishing these objects.  But Opium
produces the other effect alluded to, when given in free doses;
and this is an effect which, in the stage of the disease approach-
ing collapse, is most to be dreaded.  A leading condition in the
collapse, and one of the causes of death^s the imperfect oxida-
tion of the blood.   The whole  of this 'fluid  becomes dark and
venous; the full narcotic effect of Opium in this stage increases
the difficulty and dangers; and it is a matter of great delicacy
and difficulty, to avoid the fatal Scylla of irritation and profuse
discharges on the one hand produced by the cholera  cause, and
the equally fatal Charybdis of profound narcotism on the other
which  may be produced by the  remedy.  The most moderate
degree of the  influence of Opium which will be at all  efficient
in arresting the discharges, will diminish to  some extent the
arterialization  of the blood.  Now,  according to my observa-
tion, Quinine will enable the system to bear, without fatal results,
a larger quantity of Opium than can be borne when it is not
given.   Coffee and Ammonia are  also efficient agents for this 
Lectures on Sulphate of Quinia.           49
purpose, and should not be neglected when the discharges are
checked and the stomach will bear them; and, under the same
circumstances,  the  Quinine is also important.   I have  dwelt
upon this idea,  because I regard it as important.
    But there is another object in the treatment of cholera, at
least as this disease presents itself in some localities and seasons,
for which Quinine is much more important.   I have already had
occasion to say that different diseases are capable of combination
in the same case.  Two zymotic poisons may exert an influence
upon the system at the same time, as well as two medicines,
each modifying the effect  of the  other.
    Now, in the cholera, as it prevailed  in Chicago, particularly
in the year 1854, a malarial influence was combined with  the
cholera  cause,  as was  manifest  by the symptoms  assuming,
besides other features, a distinct periodical character.  An at-
tack of cholera, commencing  on a given hour  of one day, and
where the symptoms were all controlled, would, in many of the
cases, re-appear on the next day, or the one following, at the same
hour; and few would survive this return of the disease.   In some
of the cases, there would be a perceptible chill, accompanied, or
soon followed,  by the most active cholera symptoms, with gen-
uine rice-water discharges, collapse, and death.   It is well known
that not unfrequently in malarial fevers, when no cholera is pre-
vailing, the paroxysms are accompanied by profuse, serous vomit-
ings and purgings—and by cramps, profuse sweats, coldness, and
great depression—symptoms strongly resembling Asiatic Cholera.
When  the system  is subject to both a cholera and  a malarial
influence, should the latter produce its  characteristic chill, con-
gestion, &c, the cholera symptoms are likely to be precipitated;
a combination of the diseases exists, the cholera symptoms being
brought on by the chill and its accompanying conditions.   It is
well known that when the cholera influence is prevailing in  a
region, a variety of perturbations of the  system, such as an inor-
dinate  meal, excessive  fatigue, an active  cathartic,  &c, will
produce  attacks:  in like manner,  a  paroxysm  of a  malarious
fever, is almost sure to produce such attacks.
         D 
50
Lectures on  Sulphate of Quinia.
   The importance of Quinine in all such cases will be at once
appreciated.  It is the only reliable article in preventing such
returns.  Given in full* antiperiodic doses, as soon as the vomit-
ing is controlled and the stomach will bear it, Quinine is nearly
as effectual and important to the patient as the application of a
ligature to a wounded artery from which his life-blood is fast
flowing.  I could not tell you how many  human lives I believe
I have been instrumental in saving, by detecting this fact and
adopting this treatment.   The pleasure in contemplating these
oases is alloyed only by the memory of a few others which ter-
minated fatally by recurrence of the disease, after the patients
were thought out of danger, such  cases occurring before I
understood these  relations and before I thus used this remedy.
In the place and  at the time referred  to,  no case  was safe,
though a chill was not detected, where Quinine was not used;
When the immediate symptoms were controlled, and the Qui-
nine  was given, relapses did not occur.   I have no doubt that
very frequently in cholera these complications  exist;  and as
Quinine is so often useful for the other purposes referred to, I
can  but strongly advise, as  a general rule, that as soon as the
vomiting and purging is  checked,  Quinine be commenced in
five  or  six grain  doses,  and repeated so  that  about half a
drachm be given and  retained within a  few hours, or before
a diurnal  period  shall  return.  You may not find this advice
in your books, and it therefore should be deeply engraven upon
the tablets of your minds.
   In  a former  Lecture  I alluded to the use of Quinine in
Tuberculosis, given with a view to modify the organic  process
of the morbid ultimate nutrition by which this  exudate waa
deposited; and you will remember the pathological specimen
sent  from the Hospital in Detroit some  time since,  shown in
this  room, where old oieatrices  existed in a pair of lungs, the
patient dying  from a  combination of other diseases, but who
some three  years before  presented symptoms of  advanced
phthisis, and was  treated by Dr. Pitcher for  many  months
with  Quinine.   He took  from  two to four  grains a day for 
Lectures on Sulphate  of Quinia.          51
 nearly two years, with the  results upon the tuberculosis such
 as you witnessed.   This was a very  suggestive and striking
 case, and taken in connection with others should lead to further
 trials  of the  remedy in  this usually hopeless disease.  I have
 already referred to  the  use Of this remedy in some  cases of
 sub-acute pneumonia and bronchitis; and, in those cases where
 there  is fear of a tuberculous termination, it would seem par-
 ticularly worthy of a trial.
    In  various Cutaneous Eruptions, Quinine  has  been  used,
 and is very efficient in many cases occurring in malarial regions.
 In other chronic cases connected with debility,  it has also been
 found particularly useful in moderate but continued doses; and
 if it shall prove to increase the Solid constituents of the urine,
 and thus depurate the blood, its beneficial actions in these and
 other diseases can be more satisfactorily accounted for.
    Quinine has often been  beneficially used in Hectic Fevers
 from whatever local  cause, and it  possesses  not a little  power
 in controlling these symptoms.  Twelve or fifteen grains given
 in the course of a day, will usually arrest the chills  and check
 the other phenomena; but  while  the  original cause remains,
 they are likely soon again to recur.
    Quinine has an established reputation in various forms of
 Neuralgia.   The  impression which it is capable of producing
 on the nervous, and perhaps the secretory system also, is capa-
 ble of  relieving, in  many cases  df this  distressing and yet
 "convenient" and fashionable disease, the painful  symptoms.
 Except in cases where it is  given  in moderate and  continued
 doses, with  a  reference to its  alterative and tonic effects, it is
 only temporary in its action; and  in the ordinary forms of this
 disease, nothing  can  serve as a substitute for proper hygienic
 management and the avoidance of  the causes which so often in
 females, and those of  the other sex  of sedentary habits, produce
it.  Many neUralgies  are distinctly  intermitting in their attacks,
ftnd are in  fact masked agues.  In  these cases,  Quinine in anti-
periodic doses is strongly indicated.  Some  oases of this kind
are; much mote -Obstinate than • common intermittents; and in 
52           Lectures on Sulphate  of Quinia.
 some few cases Arsenic seems to succeed even better than Qui-
 nine.
    Quinine  has  been recommended, particularly in Paris, in
 Acute Rheumatism.  It  is given in large doses, and  there is
 high authority in favor of its efficiency.  I can not speak of it
 in this disease from my own experience, and will therefore refer
 you to the books for the evidences of its success.
    Of the particular uses of this and the other preparations of
 Peruvian Bark as a simple tonic, I shall not speak here.  The
 subject of Tonics will be discussed in a subsequent part of the
 Course, where  this article will be briefly referred to again.  I
 will simply say that it is applicable in small doses, in most  cases
 where any of the vegetable bitters are required, besides having
 peculiar powers rendering it specially applicable as a tonic to a
 large range of diseases of debility.
    There are various other special diseases to which Quinine by
 its peculiar qualities is applicable; to specify them all would detain
 us in this part of  the Course too long; besides what has already
 been said, if duly comprehended, will  lead to such a  concep-
 tion of its effects as will guide you  in  its application to other
 cases and conditions than those specially referred to.  I  shall
 now conclude the subject of Quinine, by describing somewhat
 more particularly the  use of this article in  several forms of
 malarial fever.
    All of you who are residents of the  West,  and many of you
 who live east of the  Alleghany Mountains and the Great Lakes,
 are familiar with  the different modes of  using Quinine in the
 milder intermittents commonly  called '•''Agues."
    When an attack of this disease occurs—the chill, the fever,
 and the sweat  following each other  in such rapid succession as
 to complete the paroxysm in a few hours, allowing the patient
 to arise from his bed, and perhaps to take his usual amount and
 quality of food;  if  the secretions be not  much  affected, the
tongue remaining tolerably clean;  if the bowels are in a soluble
and open state,  and the head, as the fever goes off, is free from
pain and heaviness,—from fifteen to twenty grains of  Quinine 
Lectures on  Sulphate of Quinia.
53
 may be divided into four equal parts, and, without any preceding
 or other accompanying treatment, one of these doses may be giv-
 en when the sweating has commenced, and the others repeated
 with sufficient frequency to have all taken some hours before the
 time of the next expected  paroxysm.   In many of the  cases
 such as supposed, this may be all  the treatment required.  If,
 however, the appetite be depraved or gone, the tongue be much
 coated, the skin and eyes be at all icterode, or the head remain
 painful, confused, and heavy, other treatment will be needed.
 As a general rule,  from eight to ten grains  of  Mass Hydrag.,
 combined perhaps with  an alkali, as a scruple  or more of Bicarb.
 of Soda, should be  given, and this followed in a few hours by a
 Seidlitz Powder or two, a bottle  of Citrate of Magnesia, or
 by some other neutral  salt, or a dose of Castor Oil, Rhubarb
 and Magnesia, or some  other mild  cathartic,  will be proper to
 precede the  use of the Quinine.  After this  has had its effect
 (in the mean time another paroxysm having,  perhaps, occured),
 the antiperiodic may be given in quantity and  manner as ad-
 vised before,  and the treatment may thus be ended.  If after
 this, however, the patient does  not feel quite well, being con-
 fused,  languid,  and,  as is  commonly said, "bilious," another
 similar laxative  may be needed,  but whether this or not, a de-
 purative agent,  such  as the Acetate  of Potash, to  act gently
 upon the secretions, especially the kidneys, increasing the elim-
 ination of  nitrogenized matter, will be called for.   Tonics in
 such cases  are not nearly as often  required as these depurants
 and eliminatives.
   Not unfrequently in these cases there is a  tendency to a
 re-appearance of the disease at a regular period observing the
 number seven, and  most commonly in  fourteen days.  When
 this is manifestly the case,  the  attack  may  be  anticipated  by
 an antiperiodic dose of Quinine on the day  preceding the ex-
 pected attack.   In  all cases of this kind, the condition of the
 system should be observed in reference to the use of such elimi-
natives as have here been referred  to.  I am inclined to insist
upon this, because I regard it as important.  On this subject, the 
54           Lectures on  Sulphate- of Quinia.
late Dr. Golding Bird has written with much force and clear-
ness, and  I commend  to your attention his excellent work on
Urinary  Deposits, as  containing  an  expression  of his views
on  this subject which  I endorse.
    In  intermittent  fevers of a somewhat  severer  grade than
those just mentioned, a very similar course of treatment should
be pursued.  In such cases, the preparatory and auxiliary treat-
ment is still more important; and full twenty grains of Quinine
during an intermission  will be the more certainly effectual quan<
tity.  Here, as elsewhere, the  rule of giving a full antiperiodic
quantity during one intermission should be acted upon.  Not
unfrequently in these cases  the Quinine  may be  prescribed at
the first visit,  combining it with Blue Mass or Hyd. cum Cretsit,
and after the time for the next paroxysm has gone by without
its  occurrence, as will  almost  always  have been  the case if a
scruple of Quinine has been given before the time of its usual
appearance, a mild cathartic and  the other proper depuratives
may follow.
   In Autumnal Bilious Remittent  Fevers, which are but a
higher grade of the same  miasmatic or malarial disease,  the
treatment,  though requiring some modifications,  must be con-
ducted on the same principles, as the disease is so similar.  Here
the intermissions are not distinct, at least for some time, and a
variety  of complications in the  form  of local irritations and
derangements are apt to be present.  These require some variety
of treatment to meet each case; and as a very general rule, an
impression should be made upon the secretions, the local sympr
toms should be somewhat abated in their force, and an approach
to an intermission should be secured before the Quinine is used.
Still an intermission of the fever is by  no means  essential, and
after the administration of alteratives, evacuants, and eliminatives
for one, two or three days, not neglecting the use of diaphoretics,
the Quinine may be given at the period of the greatest remis-
sion, always here  in  decided doses, and usually combined with
Morphine.   These are  the cases in which  small, repeated, and
protracted  doses are particularly to be avoided.  Be prompt and 
Lectures on Sulphate  of Quinia.           55
decided in the use of the article, or wait for a more convenient
season.  In these cases, gastric irritation and tenderness is often
present; and I can not omit to mention  that when this is the
case, a blister over the epigastrium is often very useful.  It will
generally  allay that irritation in a very decided manner, and by
so doing will often effect an intermission of the fever, and cause
the Quinine to be better borne.
    But the cases to which I wish more particularly to call your
attention, are those called Malignant  Congestive, or Pernicious
Miasmatic Fevers.
    Dr. J. H. Bailet of the United States Army, whose field of
observation in miasmatic diseases has  been chiefly  in the south-
western portion of our country, describes (in a communication to
the Surgeon-General, and recently published in an Appendix to
the exceedingly  interesting and valuable Statistical Report of
the Sickness and Mortality in the Army of the United States,
prepared  under the direction of Surgeon-General Lawson by
R. H. Coolidge, m. d., Assistant Surgeon, and issued as a public
document of the United States Senate)  two forms of what is
called " Congestive Fever," differing  in character, and often in
the treatment required;  and many years since, when miasmatic
fevers were so much more prevalent  and intense in the North-
West than at present, I had recognized the same varieties here.
    In the first, the fever comes on  in  the  usual manner of  a
severer grade of autumnal malarial fever, and is distinctly inter-
mitting in its character,—one, two,  or  three  paroxysms often
presenting nothing very unusual, though a close observer may
have noticed that during the paroxysm, and perhaps after, the
patient was a little more  stupid or confused than usual.  At
length, and sometimes  from the first,  the  cold  stage is pro-
tracted—the re-aotion does not normally occur.  The skin may
become moist; the countenance livid and sunken ; the respira-
tion laborious;  the pulse  becoming feeble, or ceasing at the
wrist; the voice husky,  or  rather faint  and whining; the vital
powers sink rapidly; and if no efficient means are used to arrest
the course  of events, the patient  passes into  a fatal  lethargy. 
56           Lectures on  Sulphate of Quinia.
This is a condition of collapse, and may occur in what are called
"Bilious Fevers" of a miasmatic origin, on the third, fourth, or
fifth day.  These phenomena seem to be the direct result of the
miasmatic or malarial poison; and Quinine is  the antidote.  It
should be administered at once and freely.  If given while any
considerable vitality is left, it seldom fails of success.  While
sensation is left, if there  be no serious local lesion, it will save
life, especially if in the lowest conditions it be combined with
stimulants.  Here it should be given largely.  The intensity of
the fever influence modifies the action of the Quinine, as severe
pain and other nervous conditions do that of Opium; and doses
of the antiperiodic that would be hardly safe in the physiological
condition, are rendered beneficial  and  highly curative by the
presence of so grave a disease.  It may  be given in doses of
from half a scruple to half a drachm, and repeated several times
if necessary.  Much larger doses have, indeed, been given with-
out apparent injurious  consequences, and with the effect of
promptly arresting the disease; but larger quantities  than men-
tioned I think unnecessary, to say the least.  All the good that
can be realized from any doses, can be produced by such as have
been named.  It must be given without regard to periods, as no
time is to be lost.
   The other form  of what is called " Congestive  Fever," is
where important organs—generally the brain or the stomach and
liver, and  sometimes the lungs—are seriously affected.   The
local lesion is congestion—sometimes active and sometimes pas-
sive in its character.   I hope you have distinct ideas  of what is
meant by congestion of an organ.  The term is sometimes used
in a very vague sense. By  congestion you understand a mor-
bidly increased quantity of blood in a part.  In active  congestion
the motion of the blood is increased in the part and generally in
the whole system: in passive, the  motion is diminished in the
part, and often in the general system also; in either case, in the
congestive  fevers I am supposing, the  functions of the organs
affected are interfered with, and the nervous system suffers by
consent, or sympathy, or  shock.  There  may, in these cases, be 
Lectures on Sulphate of Quinia.          57
   decided re-action—usually there is more or less; and if collapse
 V occurs, as it so presently does, it is the result of the local lesion
   more than of the direct action of the poison, though the poison
   has caused the local lesion.  This may be  called "Fever with
   Congestion" or "Local Congestive Fever."  The other  might
   be termed " Collapsing Fever."
      In the fever with local congestion, the lancet, cold affusions,
   cupping, counter-irritation, heat to extremities while cold may
   be applied to the head, and all  other means for changing the
   determination of the blood and the  development of nervous
   influence, may  be brought into requisition, while at the same
   time antimiasmatics are used.    These local  congestions may
   come on very early, or at any subsequent period, in th'e course
   of a fever; and the stage at which they occur, the character and
   severity of the local lesion, the general condition of the system,
   the organs involved and the  period of the  difficulty  in  which
   you are called, will all modify the treatment required.   With a
   knowledge of the pathological conditions, and of the full effects
a  of the agents which  may modify or remove them, you can not
   be at a loss  how to act.   You must not for a moment  forget
   that a miasmatic influence is  in full operation; that a malarial
   poison  is  the prime  cause of all the difficulty; that as long as
   this is acting—that particularly at the recurrence of each  par-
   oxysm  of fever—the loc 1  lesions will be almost necessarily in-
   creased ; and that therefore a leading and most urgent indication
   is to neutralize this poison.
      Still the other means for removing these  local difficulties are
   often exceedingly important, and  never  should be overlooked.
   The great importance of heat and cold for these  purposes, and
   the mode of applying them in arousing the system from  this
   congestive stupor, you will recollect  were pointed out when
   speaking  of  those  agents.  In general,  the bowels should be
   evacuated by a brisk and speedy, though not too irritating,
   cathartic, Calomel usually being an ingredient, aided, perhaps, by t \ J '•'
   enemata, or, if much depression,on the stomach be involved, the
   latter alone may be  used.  If the head  be the seat  of  active 
58           Lectures on Sulphate of Quinia.
congestion, the cathartic will be better borne.  The application
of cold will be required while heat is applied to the extremities,
with sinapisms and blisters to different portions of the surface—
sometimes cups to the temples or nape of the neck, and possibly
a venesection.  And as soon as by these means and by the peri-
odical abatement of the symptoms, some relief is obtained, the
Quinine must be freely given, but its administration must not be
too much protracted.   Make the antiperiodic impression, and
desist before irritation is produced.
   If the congestion be of a more passive character, the Quinine
may be given with more persistence, and perhaps with less care
and reserve; yet in the more active cases, you must not forget
the testimony in  favor of its action as  a sedative, and must not
desist from its  antiperiodio use,  though  an inflammation be
present.  In the passive cases, you must not neglect  the other
means referred  to for  impressing  the nervous system,  and
changing the determination of blood.
  In many cases of congestive fever, there is a combination  of
the two  conditions described—that is, local congestions exist,   •
while at the same  time a direct and powerful depressing effect
is exerted upon the system by the  malarial poison, producing by
both these means the state of collapse.  In such cases, a judicious
combination of  the same means  already referred  to must be
made; but high above all in importance and  power—as the
great agent  without  which nothing  effectual can be  done—
stands the class of antiperiodics, with Quinine  immeasureably
superior to the rest.
   I  have not,  Gentlemen,  exaggerated  the   importance  of
Quinine in the treatment of these malignant, miasmatic,  con-
gestive fevers, in the slightest degree.   The fatal termination of
a large proportion  of  these cases, if left to themselves, or sub-
jected to any other known mode of treatment, is  almost as fixed
and unerring as the decrees of fate.  This has been proven over
and over again.   When opce the  congestive symptoms have
made their appearance, marked by the coma and  the indications
of collapse, each succeeding paroxysm will produce an  increase 
             Lectures  on Sulphate of Quinia.           59

of such symptoms, and the patient  seldom survives  the  third
or the fourth.   The paroxysms must be arrested or the patient
is  lost; and Quinine with almost absolute certainty, if properly
managed, will  arrest the paroxysms.  Though  I have  treated
many cases, only in one instance has the remedy  failed.  In this
I was called at the fifth or sixth paroxysm; and should I have a
similar case again, I should try the effect of larger doses than I
then gave, in combination with more active stimulants.
    I can not close these Lectures on Quinine, without express-
ing the obligations which I believe the Profession should feel to
the Medical Officers of the United States Army, if not for abso-
lutely originating the practice of giving Quinine in large  doses
during the intermission and remission  of miasmatic fevers, and
for using it at  all during the pyrexial  periods of the same dis-
eases, yet  for "having demonstrated on an extensive scale its
Bafety and efficacy" even when inflammation was present,  "and
of having thereby largely contributed to revolutionize the  treat-
ment of these fevers in this country."
   As an offset to the many unpleasant circumstances connected
with the "Florida War," a much more perfect knowledge of the
powers and uses of Quinine was elicited from its painful experi-
ences, and doubtless by that knowledge more lives have already
been  saved than were  sacrificed in  the sufferings of that cam-
paign;  thus affording one among the constantly-occurring illus-
trations of the fact, that the Disposer of events is,

             "From seeming evil still  educing good."

And the sad experiences of sickness, wherever there are careful
and scientific Physicians, such as I hope you will be, to  observe
and reason, will tend to the continual improvement of the Pro-
fession of your choice, and in results  to humanity which  shall be

                ....." better yet, and better still,
                In  infinite progression." 
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