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FIIOWN TO UK 
THERAPEUTICALLY ALL I ED. 
BY 
/ 
W. K. BOWLING. M. 1>, 
Jtfaslpillc, <2Temt.: 
PRINTED BY W. II. F. LIGON, MEDICAL JOURNAL OFFTOU 
1868, MERCURY AND CINCHONA. 
CHAPTER I. 
High up oil the slope of the Andes, considered in tne light 
of therapeutics and hygienics, grows the most remarkable tree 
which the earth produces. Its integument, the only part of it 
valuable, is denominated by the natives, Kin Kina or bark of 
barks. The tree wearing this almost sacred coat had conferred 
upon it by Linnieus in 1742, the name of a Spanish lady of 
quality, Countess de Chinchon, who was cured by it of fever at 
Lima in 1638. Since that time its Lark is known as Cinchona 
bark. This bark, pulverized was first used as a remedy for in- 
termittent fever in London, in 1665, under the name of Jesuits 
powders. It soon fell into disuse on theoretical grounds, but an 
apothecary’s man in that city by the name of Talbor, having no 
learning and consequently no theory appropriated to himself 
what the physicians had abandoned, “got an estate in two 
months,” was knighted by King Charles the second and in lo70 
was flourishing in Paris as the great doctor, Sir Robert Talbor ! 
In 1675 the bark through the good sense of Dr. Sydenham re- 
gained its lost reputation, to some extent, among the faculty, 
but it was chiefly to the success of Sir Robert that it owed its 
celebrity and gained a hold upon popular confidence that has 4 
continued until the present. In a manuscript letter of October, 
1677 Sydenham complains that his book published a year or 
two before recommending an ounce of the bark, divided into 
twelve doses, for the cure of intermittent fever had made no im- 
pression upon the physicians of the city. After Sir Robert had 
acquired fame, rank and fortune, by Sydenham's observation 
and physicians were forced to recognize the value of the bark, 
they then remembered that one of themselves had proved and 
published the value of the medicine, and Sydenham received 
thanks from contemporaries whose obstinate folly had made a 
man of straw a popular idol. Alter Sir Robert the bark came 
into general use and for a long time bore the name of Talbor 
powder. A hundred years later one of Sydenham’s editors 
says, “the present practice acknowledges no more effectual and 
safer remedy, indeed nothing comparable to it in the whole Ma- 
teria Mediea.” Two hundred years have elapsed since the in- 
troduction of Cinchona into regular practice. From 1665 to 
1820, a century and a half, chemistry had left the crude bark 
undisturbed, or had coquetted with it to little purpose, when 
Palletier and Caventon operating upon the yellow or calisaya 
bark discovered an alkaline principle which they named “qui- 
nine,” having named a principle previously discovered by Gomez 
and Laubert “ cinchonine.” « The effect of quinine on the blood 
is differently stated by different experimenters, Legroux proves 
that after large doses of quinine the blood loses fibrine and gains 
in red globules. Briquet proves by experiment the very reverse. 
It would seem therefore that at present we have no reliable 
knowledge upon this subject. Its effects upon the nervous system 
are better understood. In poisonous doses to animals the pupil 
of the eyes is greatly enlarged, the muscular system much agi- 
tated, succeeded by torpor. Post mortem examinations show 
that the vessels of the membranes of the brain are injected. Men 
under large doses complain of vertigo, buzzing, and mental and 
physical insufficiency. Said the great orator, Haskins, under 
twenty grains of quinine, “ there is an entomological concert in 
my head and the euthanasia of my thought is disturbed.” Tern- 5 
porary deafness is one of the most common of the symptoms of 
quinine, and a sense of fullness in the frontal region al- 
most invariably follows a few medium doses of the salt. A 
sort of transient amorosis is not uncommon. Among the more 
persisting, unpleasant effects of the drug is the impression it 
leaves upon the sense of taste so that every morsel of food or 
mouthful of water taken, sometimes for d lys after, is seemingly- 
imbued with its peculiar bitterness. Still6 in his Materia 
Medioa says he has been informed of cases in which any salt of 
cinchona occasioned an eruption of urticaria. Such a case oc- 
curred in the writers family. Distressing urticaria followed in- 
variably an ordinary dose of quinine. 
Blood is a better solvent of the salts of cinchona than water. 
There is no doubt but they substantially enter into the blood 
from the skin or mucous membrane. It is said that more than 
one half of the quantity taken may be recovered from the urine. 
It would seem however, from the experiments of Briquet that 
when sulphate of quiuia was applied to the skin no trace of it 
appeared in the urine, and yet the success of the external appli- 
cation of the bark in the old practice shows that it was absorbed 
by the skin, but possibly only in a quantity as necessarily 
to belong to that fraction which in no case appears in the excreta. 
One of the experiments of M. Briquet should be remembered. 
It proves that when 15 grains of the sulphate of quinia have 
been taken into the stomach the constitutional symptoms pecu- 
liar to the drug are present in a quarter of an hour, but when 
only 6 grains were administered the lapse of an entire hour was 
necessary for its manifestation, and that when less than four grains 
were taken no sensible effect resulted. There is a peculiarity in 
the action of these salts that classes them with mercury. M. 
Baudelocquc observed that children could bear much larger doses 
of quinia without functional disturbance than adults. What a 
child four years age might take with impunity would produce 
ataxic symptoms in very aged person. When calomel was so 
much relied on, thirty years ago, opium was very generally 
administered in conbination with ic. The latter was thought to 6 
Auallify and add to the curative efficacy of the former. Of late 
years quinine and opium have become a fashionable combina- 
tion. The conbination is highly valued in a number of patho- 
logical conditions. In acute rheumatism and pneumonia this 
combination would seem to be but little less valuable than in 
periodcal fevers, the very diseases in which formerly calomel and 
opium were so much relied on. 
CHAPTER II. 
The salts of cinchona administered in conjunction with opium, 
singularly enough lose their ordinary effects, and so does the 
opium, yet the joint effects of the compound while differing es- 
sentially from those of either drug when given alone, may, not- 
withsandting, be valuable in many forms of disease. In 1858 
Gubler gave a patient with articular rheumatism four grains of 
opium combined with twenty-three grains of quinine. The ef- 
fects of neither drug were apparent. * From this and some ex- 
periments on himself he concludes that these drugs are antago- 
nistic in this way, that while it is an effect of opium to determine 
blood to the nervous system through temporarily enlarged 
capillaries, and thus induce nervous excitement, sulphate of qui- 
nine upon the contrary diminishes the calibre of the capillaries 
and deprives the nervous system of the ordinary stimulus of a 
normal quantity of blood, so that one drug qualifies the action of 
the other through this theraputic antagonism, and in conjunction 
they maintain the equilibrium of the capillaries. The recollec- 
tion of these facts will enable practitioners often to exert a skill 
in meeting the requirements of pathological conditions of many 
diseases satisfactory to themselves and patients. 
But Dr. Stille and the Dublin Quarterly will please to take 
notice that this practice of combining cinchona and opium dates 
some six generations back, and is, indeed, as old as the bark 
itself. Dr. Donald Monro in his “ Observations on the means of 
preserving the health of soldiers,” &c., published in London, 
* Sfcill6 Dubliu Quart, xliii. 9i>. 7 
J 764, says, “ this practice of giving the cortex with opiates in 
dysentery is not new, for Dr. R. Morton, in his appendix to the 
second exercise on the fevers which appeared from 
observes that after the plague of 1666 had ceu d, 
milder poison attended with gripes and dv r 
make its appearance. As the common method- 
unsuccessful, and as Dr. Morton observed exaccerb 
missions, he resolved to give the bark mixed with la d 
found it answer his expectations. Upon observing a 
he ordered a drachm of the bark, mixed with a grain v‘ 
to be given every four hours for six times, and thi- 
the fever and the dysentery.” “A fever from a a. 
says Dr. Morton, two hundred years ago, and h t i. 
De noxiis paludum effiuviis had appeared! A shadow 
coming event ! That opium has often succeeded in curio 
larinl fever there can he no doubt. In my early days a neigh- 
boring physician cured the disease with a secret powder in 'no- 
tation of Sir Richard. Desiring to know if some quini;: v 
not hid in this powder we asked a Dutchman cured by it, if k 
did not set katydids to singing in his ears ? “ No,’" said he, “ b 
made me feel ver goot and schleep ver goot.” It turned out t- 
be Dover’s powder ! Such facts as this induced Dr. Drain t- 
record that malarial fever might be classed with the neu r 
Nearly thirty years ago we attempted to prove in Dr. Dr 
Journal that “ Dysentery is but a variety of bilious fev-r” r 
did not know then that Dr. Morton had done the snr. ■ thio d ': 
years before ! Of Malarial Dropsy, Monro gives a <-as - show’ > 
the power of minute doses of calomel. “At the beginning < f 
January, 1762, one Carter, a soldier of the 11th R' ginmrtt 
foot, labored under universal anasarca, which about tv.. 
before had succeeded a flux. He made but 
that of a high color. He took a variety of 
vomits and Dover’s powder, lixivial and neuf 
infusions of horse-radish, all without off. 
small doses of calomel, three grains morn, 
the third dose he began to make water free v ... 
of January the swellings were all gone and he was shipped off 8 
to England the 8th of February, having been discharged from 
his regiment.” 
In regard to the action of sulphate of quinia Dr. Drake upon 
experiment with it said it was a tranquilizer and an equalizer”. 
Dr. Still6 say it is “a tonic stimulant when given in doses of 
medium size, as it is a sedative when administered in large 
doses.” Dr. Monett of Washington, Miss., as early as 1833 
said u it contains the febrifuge essence of bark uncombined 
without any tonic power whatever.” Dr. Drake says “ it can- 
not be regarded as a tonic in the sense that iron and columba 
are tonics.” M. Briquet says “ it is not a stimulant but a cool- 
ing! calming remedy.”* These conflicts of opinion show that the 
new steed found no harness ready-made exactly suited to his 
proportions. When more stress was laid than latterly upon 
that condition of the system called “ bilious,” much was said of 
antibilious medicine. But as calomel the leading antibilious 
remedy, by the progress of science was shorn of much of the 
trappings and decorations with which theory and tradition 
had embellished it, that pathological condition it was so often 
invoked to overcome and destroy played a less conspicuous rolt. 
in the morbid elements of diseased action. The bilious fever 
of 1830 became the periodical disease of later years and anti- 
bilious remedies were replaced by antiperiodics, so that the 
new harness for the steed, without, it was thought, involving any 
theory of its action susceptible of dispute, was very generally 
labeled “antiperiodic.” But it will be seen that this cognomen, 
this creation of a new class of remedies to accommodate a fastidi- 
ous stranger, did involve a theory, and we do not hesitate to say 
an erroneous one. Whatever the sulphate of quinia may he, it is 
assuredly not an antiperiodic, notwithstanding its wonderful 
power in a disease preeminently intermittent. There are dis- 
eases in which the pathological condition of periodicity is as 
conspicuous as it is in intermittent fever. This is indisputably 
so in many cases of asthma, in epilepsy and in hectic, not to- 
mention other affections. In all of these this salt is confessedly 
inutile and inoperative. Now this could not be so if its claims 
* StillS. to antiperiodic power were well founded and legitimate. True 
in intermittent fever, conspicuously periodical, its triumphs first 
secured it immortality. But periodicity in intermittent fever is 
a pathological condition of secondary importance. The primary 
and distinguishing element of pathology is derangement in the 
biliary functions, the “ biliousness” that superficial observers 
would discard because of the theory, partially false, that chained 
it to the once triumphal car of calomel. It is precisely where 
this pathological condition exists in disease that the sulphate 
of quinia acqures reputation and this whether periodicity 
be associated with it or not. In intermittent fever, or 
any variety of malarial fever there are two pathological 
conditions, to which one more—inflammation—is added in 
the inflammatory varieties. In all the forms of this fever 
quinine is triumphant. But we have shown in diseases in 
which 'periodicity does not exist in association with derange- 
ment in the biliary functions, quinine is useless. Again, mala- 
rial jaundice is as much a disease as malarial feVer. One i9 
a non-febrile zymotic and the other a febrile zymotic, but they 
are both dependent upon the same zuma. One acknowledges 
two pathological elements, periodicity and derangement in the 
biliary function, and is amenable to quinine ; the other rests 
upon a single pathological condition, biliary derangement, and 
is equally amenable to the sulphate. So that whether biliary 
derangement exist alone or in conjunction with periodicity qui- 
nia is equally effectual, but where periodicity exists alone or in 
common with pathological conditions not involving the biliary 
organs, quinia utterly fails. It can not, therefore, be and anti- 
periodic. But as its triumphs are where biliary derangement is 
conceded by all it is preeminently an antibilious medicine of 
wonderful power. 
CHArTER III. 
A hundred years ago Donald Monro, of London, records, 
■while surgeon of the British army, as a most remarkable fact, 
that jaundiced soldiers with intermittent fever recovered much 
quicker than those jaundiced that had no fever. Those with 10 
intermittent fever of course, took bark, those who had no fever 
took no bark. The former recovered quickly, not because they 
had intermittent fever but because they took the bark. This 
Monro seems not to have been aware of. In 1863 the assistant, 
surgeon of a regiment came to me, yellow as an orange, with a 
prescription from his senior directing him to take bichloride of 
mercury every night for forty nights. We advised him ta take 
3ss of quinia a day for five days and get well in one eighth 
of the time. He took my advise and rapidly recovered. He 
related his case to many army surgeons, none of whom could be 
persuaded that quinine was a “ colagogue,” which, indeed, it was 
not. Malarial dropsy from enlarged liver is cured in the same 
way. In every form of malarial disease, continued, as dropsy 
and jaundice, or periodical, as intermittent fever and neuralgia,, 
biliary derangement is a fundamental pathological condition, 
and to this rule there is no exception, and whatever has power 
to remove this primary effect of malaria cures these diseases or 
these varieties of a disease. 
The Greeks and Romans knew nothing of mercury, and its- 
employment as a medicine was introduced into Europe from 
Arabia, whose physicians employed it externally in skin diseases, 
the notorious Paracelsus being the first to administer it inter- 
nally in the early part of the 16th century. Lauded in syphilis, 
which about the same time attacked the human family with 
such violence as to threaten its extinction, long after regarded 
almost as a specific in the tropical fevers of the southern frag- 
ments of the British Empire, and more recently wherever “ bili- 
ous’' fever prevailed, until it claimed empire co-extensive with 
the domains of pathology, and medical logic was principally em- 
ployed in excogitating ingenious hypotheses as excuses for its 
administration, until it was by acclamation crowned king of the 
Materia Medica. Like other kings, however, it could not com- 
mand the universal suffrage of its own subjects. A few always 
disputed its right to empire and regarded its government as c?e- 
facto only, and these few, like the miniature cloud seen by the 
prophet in the heavens, grew into stormy proportions and scat- 
tered the hosts of the mercurial despot. To this pretender, 11 
wanderer and vagabond upon the face of the earth, vre would 
do justice. We recall the thousand instances where it ha* 
been a boon of mercy to those sick of malarial disease, and 
babies under three years of age find it an anchor of safety in their 
fevers and diarrhoeas. Every practitioner in the interior valley 
of North America below the forty-fifth parallel of north latitude, 
or on the Atlantic slope below that line, who has been in prac- 
tice the third of a century knows that all the forms of malarial 
fever recognized by writers have yielded to calomel and tartar 
emetic. Kush’s powder of one sixth of a grain of emetic tartar, 
one grain of calomel and ten grains of nitrate of potash 
has cured thousands of cases of the severer varieties of malarial 
or bilious fever. No one doubts now, whatever the “ solidists” 
have recorded against it, that mercury is absorbed, like other 
medicines, into the circulation. We have the highest evidence 
that it not only enters the blood but that it changes its character; 
for blood drawn during salivation shows an increase of huff. 
Patients under its influence become palid, showing a diminu- 
tion of the red corpuscles of the blood. Dr. Samuel Wright 
proved that during salivation the blood “ abounds in fetid, fatty 
matters ; and that it is more than ordinarily prone to decompo- 
sition.” The fetid, fatty matters loading the blood in mercurial- 
ized patients are doubtless due to the rapid disintegration of tissue 
produced by mercury, the debri seeking the blood as a carrier to 
the excretory outlets of the body. Orfilia proved that the ani- 
mal organism is less tolerant of mercury than of any other metal. 
All parts of the system seem to be thrown into commotion by 
its presence and its entire dynamics employed in expelling the 
invader. He found traces of lead, copper and silver six or even 
eight months after being takeu, but no trace of mercury could 
be obtained after eighteen days. Where it can not be got out 
of its dominions it would seem to be shoved into nooks and cor- 
ners as much as possible out of the way of the working appa- 
ratus, as at least incompatible with its normal action. But 
mercury in small doses, with a view to its alterative effect, does 
not arouse such opposition in the general system. The liver 
* Wood’s Therapeutics. 12 
seems to feel doses astonishingly minute. Experimenters have 
agreed that very minute doses in health occasioned a brighter 
yellow in the alviue discharges, and that the subjects experi- 
mented on very generally complained of slight griping pains in 
the bowels. It would seem that the color of the discharges is 
owing to augmented secretion of bile and that the griping is 
occasioned by the presence of more bile than usual. All prac- 
titioners have attended patients so susceptible to mercury as to 
suffer hypercatharsis from a few grains. 
Headland has shown that whatever goes into the stomach 
capable of solution goes out of the stomach through the radicals 
of the vena portre, and through this vein into and through the 
liver ; in transitu coming into contact with every ascinus of 
of that viscus. Mercury is no exception to this rule. That it 
goes into the circulation has been proved, and that it could reach 
the vital current, without having been dissol ed is a physioloT 
gical impossibility. The first force of the medicine,, then, is 
expended upon the secreting surface of the liver, which is the 
first organ engaged in separating the intruder from the blood 
that it may at the very threshhold of the glandular dynamics of 
the organism be thrown back and cast out. The general, circu- 
lation, very probably in a large number of cases, where mercury 
has been administered, in this way is saved from the contamina- 
tion of the presence of the mineral. But if the hepatic gateway 
to the general circulation through the hepatic vein is left open, 
a part of the medicine takes the course of the blood and is car- 
ried to every part of the system, promoting disintegration and 
loading the current of the circulation with effete matters to be 
got rid of through the various emunctories of the body. It is 
only when mercury reaches the general circulation through the 
portal, either from the quantity taken in being beyond the 
eliminating force of the liver, however aroused to energy of 
demonstration by the stimulus of its presence, or where from 
enfeeblement ot that organ by the presence of malaria in it$ 
congested vessels, or other causes, it is unable to resist the pas- 
sage even of the small doses ot this drug through its dominions, 
that salivation is possible. 'This latter effect iu practice, in all 
conceivable pathological conditions, is deprecated by all save 13 
ical barbarians. In inflammatory fever, and zymotic fever* 
of high grade, absorption from the gastric surface is often for a 
considerable period suspended. Eveu water will not pass into 
the radicals of the vena portae ; and in cholera, by a sort of in- 
verted dynamics, a centrifugal direction to the skin or to the 
gastro-intestinal mucous membrane is given to all the fluids o 
the body by which absorption is prevented. In such cases mer- 
cury does not even enter the portal circulation which accounts 
in these cases for the absence of salivation after repeated doses 
of that drug. When sucli fevers abate of themselves, or the 
cholera poison has exhausted itself, or been eliminated, absorp- 
tion returns, the last doses of mercury are drunk up by the radi- 
cals of the vena portarum, pass the liver, enfeebled by the general 
disease, and raise a salivation. The salivation occurring about 
the time of recovery, is set down as its cause, whereas it is a 
legitimate effect of established physiological and pathological 
laws. 
The natural cure of a malarial fever takes place with, or im- 
mediately after, a free discharge of bile, in a sort of critical 
diarrhoea, and it was an effort, often successful, to imitate nature 
that those drugs were administered in this disease that were con- 
spicuous for power to establish just such a diarrhoea ; a diarrhoea 
in which there was an abundance of bile. There can be na 
doubt that malaria which is the efficient cause of the disease 
often both the predisposing and exciting cause, is in this way 
“ purged out.” 
For a long time, then, mercury was invoked for the cure of 
malarial fever, then called “bilious” fever. Now sulphate of 
quinine is called in requisition to the same end, but as it is an 
“ anti periodic,” the disease has had its nomenclature coquetted 
with and corrupted so as to change it into “ periodical” fever. 
Now no one ever regarded mercury an antiperiodic. So wo 
have no excuse for mercury in “ periodical” fever, Yet our most 
judicious practitioners, while they accept the change of nomen- 
clature, by no means subscribe to the theory it was intended to 
inaugurate, but are fond of a mercurial purge” and quinia. 
The learned and philosophic physician, (for a man may have 14 
much learning and lie destitute of philosophy, or common sense), 
routines his administration of calomel to that pathological con- 
dition manifested by biliary derangement, or to syphilis, from 
some undefined conception of a specific power it lias over this 
disease, or to the fevers and diarrhoeas of children where there 
is always a disturbance in the hepatic function, if indeed this 
altered function is not invariably the fans ct origo of their sim- 
ple fevers and bowel affections. As to its power in eliminating 
hydro-carbon, and other impurities of the blood, which practi- 
tioners very commonly alledge as an excuse for its administration, 
we have shown that it loads the blood with these very impurities. 
“ There is no cholagogue which approaches in efficacy some of 
the preparations of mercury.” Cholagogue, from chole and ago, 
1 expel.” Of this there can be no sort of doubt. But, then, 
we must give the same signification to the word as did the an- 
cient physicians, “ expeller of bile.” Because a medicine has 
more power than another to expel bile it is the better “ chola- 
gogue,” but this does not prove that it is the corrector of that 
pathological condition to which authors so often refer as impaired 
hepatic function. It is not only a cholagogue, but it is something 
better, it is eminently “ anti-bilious.” While quinine is its 
superior in anti-bilious power, (its most constant and remarka- 
ble demonstration), yet that salt possesses no cholagogue quality 
whatever. We possess then, here, “ two strings to our bow,” 
which judicious practitioners will prefer to one. As we have 
two valuable emetics, one mineral and one vegetable, and valua- 
ble cathartics from either kingdom, it is not surprising that na- 
ture had also treasured up from each division.medicines possess- 
ing power over bilious diseases. 
We often need these two strings, badly. A child of Mr. E., 
(Park st.), 8 years of age had, I thought, intermittent fever, for 
which 1 prescribed 12 grains of quinine in four doses, and it 
failed. The child took 16 grains before the next paroxysm, and 
the fever returned, notwithstanding. Twenty grains were given 
in the next twenty-four hours, with the same want of effect. I 
now ordered 10 grs. of calomel at night and next day tlie child 
took 16* grains of quinine and was well. 15 
This autumn, a son of Judge , on Spruce street, 14 years 
of age, sickened. I was physician in ordinary, but being out of 
town, another physician was called. 1 saw the case with him 
the same evening. We both thought he had intermittent fever 
of the soporose kind. He had got leeches to his temples before 
I saw him, and a dose of calomel. He was much better next 
morning, took quinine in ordinary doses through the day, and at 
night his fever returned with great violence, with a return ot the 
unpleasant head symptoms. My medical friend saw him with 
me at each visit. He now said that he had changed his opinion 
of the disease of our patient—that we were mistaken in sup- 
posing it to be intermittent fever, for he had inflammation of 
the brain. I replied that I saw no cause for changing my opinion, 
that I felt sure of my ground and that the boy had to be treated 
for intermittent fever, and that I felt peculiarly grateful to God 
for giving me sufficient understanding to detect the true charac- 
ter of the disease, and firmness enough to insist upon the proper 
treatment, for if he were treated for inflammation of the brain 
he would die, certainly. A dose of calomel was given that night 
and the accustomed quantity of quinine next day, when the boy 
was well and has remained so ever since. 
Three weeks ago two beautiful twin boys, three years old, sons 
of Mr. G. W. C., North High st., sickened with scarlet fever. 
It was of the simple variety, and while there was a good deal of 
fever and a copious rash, the children did very well. One had 
a swelling and suppuration below the right ear, with a slight 
intermittent fever in the second week. The twins had been ex- 
posed to malaria in the country in the hot months. I ordered a 
few grain doses of quinine and the fever left him. Shortly after 
this the other twin took well-marked intermittent. I ordered 
quinine, as I had for the first. It utterly failed. It was re- 
peated, and failed. The quantity of quinine was trebled, and 
failed. The parents were wretched, but I told them not to be 
alarmed, for I knew how to relieve him. I then gave him 3 
grains of calomel at night and 4 grains of quinine in the begin- 
ning of the sweating stage of the fever. I found him next 
morning with his brother grabbling in a market-basket of hicko- 16 
rynhts. He was thoroughly cured* and as I riet'er give tUedicine 
to well people, I substituted good fore for “ tonics,” and lot him 
alone. He remains well. I have often thanked Providence for 
these “ two strings” to my anti-bilious bow. 
Livingstone, (Expedition on the Zambesi in Africa, n. 95), 
says his quartermaster, Mr. Walker, took violently sick. 
“ Walker’s being a severe case, a large dose of calomel was at 
once administered. This sometimes relieves when other reme- 
dies fail, but the risk of salivation must be run. When 20 
grains are taken it may cause an abundant of flow of bile, and 
a cure be the result.” “ Quartermaster Walker soon recovered.” 
“A remedy composed of from six to eight grains of resin of 
jalap, the same of rheUbarb, and three each of calomel and qui- 
nine, made up into four pills, with tinct cardamus, usually re- 
lieved all the symptoms in five or six hours. Four pills are a 
full dose for a man—one will suffice for a woman. Quinine 
after, or during the operation of the pills, in large doses every two 
or three hours, until deafness oi cinchonism ensued, completed 
the cure.” 
A medicine we understand to be a substances endowed by 
God with an atiribute that distinguishes it as much from other 
substances as the soul of man distinguishes him from the other 
animals. This sanative property inherent in the drug is the 
soul of that substance, all else pertaining to it is a mere conge- 
ries of elements to form the habitation for this sanative autocrat. 
In disease all observers have recognized a sanative power 
ceaslessly at work to ward off the deliterious iufluenceof exciting 
causes, or failing there no less persistingly engaged in rescuring 
the organism from the effects of actual disease. The archceiis, the 
unima the vis mediccitrix naturce. Whatever can aid this prin- 
ciple is a medicine. Now we supose that this principle, (and 
others supose, for this is by no means original,) can be aided 
only in one of two ways. 1st, Directly, by the force of the med- 
icine being added to the force of the vis medicatrix, or secondly 
indirectly by the force of the medicine stimulating the vis med- 
icatrix to do what it could riot d > without such stimulus. Ever) 
one knows that malaria when it gets possession of the system 17 
invariably affects the |liver, always in some way disturbing its 
function. It may be that this derangement occurs in the liver 
during an effort to eliminate malaria from the blood. It certainly 
transmits malarial blood slowly, and is subject to congestion and 
enlargement in the effort. In this way malarial dropsy is pro- 
duced. The blood loses its corpuscles under the poison, and the 
vessels that circulate it lose their resiliency and tonicity, for the 
want of healthy nourishment, while the liver enlarges, and the 
notch in the posterior border through which the vena cava ascend- 
ens passes, presses that vessel, as if held between finger and thumb, 
and this obstruction produces congestion near the radicals of 
this vessel and a transudation of the watery part of poor blood 
through the parieties of flaby, because imperfectly nourished 
vessels, into the subcutaneous areolar tissue ensues, which being 
permeable,-when the patient is erect the fluid gravitates, and the 
ancles swell, but when the patient is horizontal for several hours 
the swelling disappears by reason of the fluid that produced it 
being dispersed along the permeable tissue. The liver transmits 
the blood brought to it by the vena port* slowly, and it accumu- 
lates in it as a consequence, and the radicals of that vein being 
near the cavity of the peritoneum, that sac becomes’a reservoir of 
the water of the blood. We know that in malarial dropsy the 
ankles visibly swell first while in the drunkards dropsy the ab- 
domen first swells, and these are varieties of hepatic dropsy. 
In the former we can readily understand how minute doses of 
calomel, changed in the stomach to bichloride and thus rendered 
soluble, may enter the liver as above described, and so operate 
on the gland, and conseqently its function, as to diminish its 
bulk, take off the “ pinch” on the ascending cava that its radicals 
may drink up and carry away the fluid about the ankles, facili- 
tate the transmission of blood from the vena portae that its rad- 
icals may take up the effused fluid in the peritoneal saer. At all 
events small doses of calomel, with or without squills, have 
cured many cases of malarial dropsy. That malaria produces 
jaundice by some unexplained influence on the liver all agree 
and calomel for jaundice is universally prescribed. 
We are obliged to the patient enquiring of Dr. Norcomb of 18 
North Carolina, as shown in an addres delivered before the Med- 
ical Society of his state in May last and to the good taste of 
the Editors of the Chicago Medical Journal for the republication 
of its substance from which we make the following extracts : 
“In a lecture delivered by Sir Wm. Fergusson, at the Royal 
College of Surgeons of England, in June, 1866, I the find fol- 
lowing 
“ The loss of confidence in much-vaunted remedies seems, in 
some respects, like a loss or diminution in our appliances—an 
abstraction from our powers, as it were. But in my opinion the 
correct view to take here is, that we are acquiring a knowlege of 
our own ignorance—that we are begining to see that we have 
placed our faith erroneously. In short, that we have been 
taking honor to ourselves for that which has been justly due to 
nature. We begin to see the difference between blind empiri- 
cism and natural processess.” 
“ Says Anstie, on this point: 1 “ Without an observation of 
natural processes no medical man ever did great things for man- 
kind, or for the advance of his art.” ’ * * * * ‘ “ It 
was but yesterday that disease was universally regarded as some 
thing entirely foreign to the vital organism, which came to it 
from without, resided in it for a time, and then departed, exor- 
cised by the physician’s art.” 
And says Prof. P. Hughes Bennett ; “ If every young prac- 
titioner would dedicate his life to the careful elucidation of the 
natural progress of only one disease, he would do more for med- 
ical practice than has been accomplished by centuries of empiri- 
cal trials of remedies.” 
And Dr. Todd, one of the brightest medical lights England 
ever produced, remarks thus : “ Internal inflammations are 
cured, not by the ingesta administered, nor by the egesta pro- 
moted by the drugs of the physician, but by a natural process as 
distinct and definite as that process itself of abnormal nutrition 
to which we give the name of inflammation. Our inter- 
ference either may aid, promote, and even accelerate this natu- 
ral tendency to get well; or it may very seriously impair and 
retard, and even altogether stop, that salutary process.” 19 
Prof. T. Galliard Thomas says : “ If fifty cases of pleurisy 
(the disease for which Sydenham prescribed so vigorously) be 
placed in bed, carefully nursed, dieted, guarded from deleterious 
influences, and receive not a particle of medicine of any kind, 
the probabilities are that not one case would end fatally." 
“ Dr. Garrod tells us that he has seen many cases of severe 
rheumatic fever get rapidly well without the use of drugs, and 
that on simply colored or camphor water the improvement is 
often very quick and decided. In the Guy's Hospital Reports 
for 1865, are forty-one cases of rheumatic fever, thirty-seven 
treated by Dr. Gull, and four by Dr. G. 0. Rees, ‘ scarcely any 
medicine except mint water being given.' Twenty-two were 
males, nineteen females ; two only above the age of forty, the 
rest under thirty-five. The heart is mentioned as impliclated in 
a large number of them. The average nnmber of days from 
admission into hospital to complete convalescence was, for the 
males, sixteen, females twenty-one. The average duration of 
the acute symptoms in seven cases in which there was no evi- 
dence of the heart being involved, was eight days ; in six cases 
in which the heart was decidedly affected, twenty-three days." 
“ Dr. Dickson says, in life itself, there is a resistive force—an 
inherent curative power—that frequently thwarts, in the lan- 
guage of Dr. Thomas, ‘ the machinations of misguided men."' 
Dr. Chambers says, .“That disease is, in all cases, not a posi- 
tive existence, but a negation ; not a new access of action but 
a deficiency ; not a manifestation of life, but partial death ; 
and therefore that the business of the physician is, directly, or 
indrectly, not to take cnoay material, but to add ; not to dimin- 
ish function, but to give it play ; not to weaken life, but to 
renew life." 
Says Prof. Austin Flmt, “ Certain it is that diseases, which 
do not compromise directly the function of either the heart or 
lungs, can not kill so lung as the nutrition of the body is main- 
tained at a point compatible with life.” 
Dr. Jackson, in speaking of pneumonia, says : “Where the 
constitution of the patient is good, little more is required than 20 
to watch the course of the disease ; the inflammation will take 
care of itself. It is the patieDt himself who is to be carefully 
looked to ; his forces, which are to carry him through the con- 
flict, are to be judiciously sustained, and all disturbing causes, 
moral and physical, guarded against. In cases of pneumonia, 
and where the antiphlogistic treatment had been fully carried 
out, convalescence is difficult and protracted. I have known two 
deaths to occur evidently from exhaustion. A limited portion 
of'a lung had been the seat of the disease, and was nearly re- 
stored to its natural state, and yet death took place with the 
disease extinct. Prof. G. B. Wood says there is reason to be- 
lieve that in pneumonia, patients have been starved.” 
Schonlein said, “ Good physicians often S6e no indication for 
treatment, bad ones never.” 
“ There are those who, either ignorant of, or disregarding the 
golden truths and facts of Modern Medicine, cling to tradition 
and views long since utterly exploded, and vaunt the success of 
a practice opposed to physiology and pathology—yes, it seems 
to me, to common sense. I refer to the so-called antiphlogistic 
treatment, which originated long ‘ere modern phsiology rent the 
veil of therapeutical empiricism/ and the fatality of which is 
leading daily to its abandonment. This practice has no basis 
hut tradition and empiricism. Scientific practice must have 
phsiology for its basis. In the language of George Harley : ‘A 
knowledge of organization, important though it be, is yet less 
indispensable to the physician than a knowledge of healthy func- 
tion, for it is the latter which elucidates the dark problems of 
life, it is the latter which proves the golden key to the compre- 
hension of disease.’ And says Chambers : ‘ Is it not then ob- 
vious that the only sure mode of arriving at a knowledge of the 
deficiencies of vital powers, or diseases, is by a knowledge of 
those powers of which they are deficiencies P The physiologist 
is the only true pathologist.’ And in part I, of Todd, Bowman 
and Beale’s ‘ Physiological Anatomy and Physiology of Man’ 
the latter says : ‘ Pathology is is the physiology of disease ; 
and, it is obvius, that no pathological doctrines can command 21 
confidence/which are not founded upon accurate views of the 
natural functions. It is also certain that improvements in pa- 
thology must follow in the wake of an advancing physiology.” 
Haberson says : “Any remedy that has been supposed to pos- 
sess properties by which this so-called inflammation could bo 
checked, has received the name antiphlogistic, and mercury 
stands foremest amongst them ; but water or brandy often ful- 
fil a similar purpose, and many agents possess equal power in 
this respect. This phraseology is a vestige of days of ignorance, 
and has only hypothesis to rest upon. In medicine, however, we 
still retain the antiphlogistic remedy ; and too often diseases 
are considered as conditions requring to be smothered out, un- 
fortunately also by frequently extinguishing the patient.” 
1 “ Mercury/ says Headland, (accepting the experiments of 
Wright,) ‘ by some destructive agency, deprives the blood of 
one-third of its fibrin, one seventh of its albumen, one-sixth or 
more of its globules, and at the same time loads it with a foetid 
matter, the product of decomposition. Such power is possessed 
by few other medicines, and certainly exerted by none in the 
same degree as mercury. It is an agent of terrible activity, and 
we may well be cautious how we handle it. Mercury wastes the 
frame, causes the body to become thin and feeble, the face pallid, 
and diminishes the nervous energy.” 
Habershon says : “After mercury has been taken for some 
time, the general nutrition of the body is impaired, the blood 
becomes dark, the coagulation of its fibrine less firm, and the 
proportionate quantity of serum increased, the red corpuscles 
are diminished, and the patient becomes thin and blanched. 
His tissues lose their proper tone, his muscles become flaccid, his 
energy diminished, and his nervous system enfeebled.” 
Tanner, in his work on the Practice-of Medicine, savs ; 
“ With regard to the use of mercury, there appears to be every 
reason to believe that its utility in controlling inflammation, or 
in promoting absorption of the effused products, has been very 
much overrated ; and indeed it seems highly probable that in- 
flammatory diseases will progress more favorably without the 
use of this medicine than with it.” 22 
Dr. Todd says : “No one would venture to assert that mercu- 
rial influence, however quickly induced, ever checked pericarditis 
or.pleurisy ; nor would it be easy to adduce an instance in which, 
with any reasonable degree of certainty, it could be stated that 
mercury broke down adhesions, or prev nted their recurrence.” 
Says Dr. Garrod : “For many years I was in the constant 
habit of administering calomel in cases in which inflammation 
of the heart was present, but for the last eight or ten years, I 
have not done so as frequently, and have no reason to regret the 
change of practice ; the cardiac inflammation appears to have 
yielded quite as readily, and the patient, on the subsidence of the 
fever, has not had to suffer from ptyalism in addition to debility.” 
Dr. Bennett says, “ To secure the safty of the fortress—let us 
try to bring individual up to his physical status.” 
And Dr. Hewett says ; “Nutrition is the basis of the treat- 
ment of disease, and no other is possible for a rational system of 
medicine.” 
Mr. Skey says : “A weak condition of the animal body is in- 
toligible enough, but an abnormal condition warranting a re- 
duction of vital power by artificial agency I can not under- 
stand.” 
Says Dr. Chambers : “ Is it nothing to stand sentry against 
the fatal seductions of polypharmacy ?” 
CONCLUSION. 
Sulphate of Quinine is not a tonic, as Dr. Drake proves— 
is not an antiperiodic, as we prove above, but is preeminently 
antibilious. A specific remedy in a variety of diseases acknowl- 
edging the same specilic cause, and without curative power in 
any form of disease not a product of this cause. Not a cliola- 
gogue or “expeller of bile” 1 think, though many southern phy- 
sician differ with me. Not prophylactic in small doses every 
day, as proved by Livingstone, but decidedly prophylactic when 
given fjin medium doses every eighth or ninth day as proved 
by Sydenham. The preparations of Murcury are curative 
wherever Quinine is curative ; and beyond this boundary, 23 
precious in the fevers and diarrhoeas of babies—if these dis- 
eases are beyond the malarial boundary, which Dr. Webb 
and Dr. Wright, of this State, dispute, and cure with 
Quiuia—or at least their diarrhoeas, in the hot months. 
Precious, surely, in one form of syphilis, but in the zymotic 
fevers, except the malarial, and local non-malarial phleg- 
masiae, useless, to say the least. Here, where it can do nothing 
but harm to the patient and injury to the profession, let it be 
omitted. Its abuse here has swept away a moiety of the income 
of the profession, and placed it in the coffers of its maligners. 
Stop it here ! Cinchona and mercury are further shown to be 
therapeutically allied in their prominent physiological phenom- 
ena or pathogeneses, in that they furnish the only examples of 
children bearing larger doses than adults, and an exanthematous 
rash being common to both, in many cases. 
ERRATTA. 
No one can be more painfully conscious of the many errors in this hastily pre- 
pared pamphlet than the Author. He begs of those who may see" proper to real it 
that each will correct it for himself.