ERYSIPELAS: 
ITS TREATMENT WITH SULPHATE OF QUININE. 
ZB~Z" 
Y. R. LeMonnier, M.D., 
Visiting Surgeon Charity Hospital, New Orleans; Member N. 0. Medical 
and Surgical Association. 
From “The New Orleans Medical and Surgical Journal,” November, 1874, 
Jas. A. Gresham, Print, 92 Camp Street, N. O. THE 
NEW ORLEANS 
MEDICAL AND SURGICAL 
JOTJEISTAL. 
NOVEMBER, 1874. 
ORIGINAL COMMUNICATIONS. 
Article I. Erysipelas; Its Treatment with Sulphate of Quinine. 
By Y. R. LeMonnier, M.D., Visiting Surgeon Charity Hos- 
pital, New Orleans ; Member N. O. Medical and Surgical 
Association. 
The term erysipelas is a Greek one, signifying a tendency to 
spread. It is an exanthematous disease, characterized by an 
eruption sui generis. “Erysipelas,” says Dr. Gross, “is not only 
a frequent but a most formidable disease. Produced by various 
causes, both local and constitutional, it may exist as a primary 
affection, or occur as a complication of other lesions, modifying 
their character, interfering with their evolution, and even at 
times entirely supplanting them.” 
The disease is said to be idiopathic if it depends on some con- 
stitutional vice, or traumatic if it be associated with an external 
injury. It occurs at all ages, and in both sexes. Whether or 
not temperament exerts any influence upon its production is as 
yet unknown. “Nervous, irritable, and intemperate persons,” 
says Dr. Gross, “are particularly subject to it.” Judging from 
the number of “alcoholics” among the observations which follow, 
I conclude that alcoholism might be looked upon as predisposing 
to the disease. I did not notice any tendency on the part of the 
nervous and irritable temperaments to influence the march of 
the disease. Case No. 10, in which the exanthema seemed to be 308 
Original Communications. 
[Nov. 
most persistent, and where it will be seen to have returned at 
three different times, was a man of remarkable phlegmatic tem- 
perament. 
Erysipelas prevailed in my ward epidemically for five months, 
during which time I was not a day without one or more cases. I 
have been often obliged to postpone all operations in which delay 
was admissible, for fear of giving rise to it. The smallest 
scratch was often the starting point, bringing on an attack which 
was more or less severe, and in fact, fatal in one instance 
(Case 12). 
Apart from the cases in which alcoholism seemed to be a pre- 
disposing cause, I cannot account for the other cases in any other 
way, except by a vitiated state of the atmosphere of the hospital, 
which, during the whole winter, had not been without erysipelas 
in some of its wards. This had caused me to anticipate the 
distemper, for several months before it made its appearance in 
my ward. It will not be amiss here to state that, whereas my 
colleagues had erysipelas among their patients, I had pyaemia 
among mine. Of the latter disease I had three cases, closely 
following each other, in beds adjoining each other. Two of these 
died and one recovered. Those who had pyaemia did not have 
erysipelas, et vice versa. Once the latter had made its appear- 
ance, the former disappeared. 
My object here is not to write a treatise on erysipelas, but an 
essay uon its treatment with sulphate of quinine” stating what, in my 
opinion, is the modus operandi of this drug in this disease. The 
theories here put forth are based on recent experiments and dis- 
coveries made by different authors. The result of this treatment 
cases/ eleven cures and one death. 
Among the many theories concerning the pathology of erysipelas, 
one in particular has attracted my attention as probably the most 
correct. It is the one which considers the infiltration of the skin 
of erysipelatous parts, by the white corpuscles of the blood, as be- 
ing the probable cause of the disease. Upon this is based the 
quinine treatment. In 1868, M. Yulpian, and after him, Koster, 
Yolkmann, and Studener, reported, as the result of their investi- 
gations, the presence of a large amount of white blood globules, 
infiltrated in the thickened tissues of the skin of erysipelatous 
parts. M. Yulpian (Archives de Physiologie, 1868, p. 316.), says: 
“In thin slices of the skin which have macerated in alcohol, it is 
easy to recognize a thickening of the tissue, and the presence of 1874] 
LeMonnier—Erysipelas: Sulphate of Quinine. 
309 
a large number of leucocytes. They are so numerous, that in many 
places they are contiguous to each other. In slices that are not 
very thin, the greater portion of the dermic fibre is hidden by 
them. They are disseminated throughout the thickness of the 
skin, being more numerous in the papillary layer and its neigh- 
borhood than in the deeper portions. These leucocytes are not 
to be found, except in very rare instances, in the subcutaneous 
cellular tissue. I am satisfied that they are colorless globules, 
from their similarity to those of the blood and pus, and from their 
form and their dimensions. Also from the result ot the action 
of acetic acid, which caused them to fade, and show the pre- 
sence of 1, 2 or 3 small nucleoli with distinct borders.” 
On the 25th of last April, I examined the liquid contained in 
the phlyetente of erysipelas (Case 3), and found it to be composed 
of a large amount of white corpuscles. Xot a single red one was 
to be seen. 
It would seem that these globules are rapidly absorbed, and 
disappear, since 2 or 3 days after the disappearance of the exan- 
thema they are not to be found.* 
Such, therefore, are the facts as seen with the microscope. 
But to what is due this great accumulation of leucocytes is the 
next and more difficult problem to be solved. Many theories are 
brought to bear on this point. But theories must do when we 
cannot do better, yet they only serve to hide our ignorance. The 
facts reported by Waller, of London, in Philosophical Magazine, 
in 1846; those of Conheim, of Berlin, relatiug to the transuda- 
tion of the white corpuscles of the blood through the parietes ot 
their blood-vessels, were disbelieved. M. Vulpian himself, while 
writing the result of his microscopical examinations, did not 
then (1868) know how to account for it, and rejected tfie theory 
of Waller and Conheim. Further on he says, uCependant il y 
avait qnelques leucocytes dans la paroi de certains vaisseaux; mais 
assurement c'etait Id une exception” (And yet there were a few 
leucocytes in the parietes of certain vessels; but assuredly this 
was an exception). He finishes his article thus: uOn a cherche 
a voir si l’on ne pourrait pas, dans ce cas, reconaitre le mode 
d’origine des leucocytes, dissemiues, en si grand nombre, dans le 
derme; mais on n’a pu arriver a se former les preparations sous 
les yeux, ancune idee nette sur ce sujet” (In vain we tried to 
account, in this case, for the origin of the leucocytes, dissemi- 
*PerroUd, Annals de Dermatologie and da Syphiligraphie, 1869-70, p.242. 310 
Original Communications. 
[Nov. 
nated, in such great number, in tbe dermic tissue. With the 
preparations under our eyes we could obtain no satisfactory, 
result). Such was his language in March, 1868. But since then, 
new facts were made known, those of Strieker, in 1867,* Prus- 
sack, of Vienna, etc., confirming the conclusions of Waller and 
Conheim. Finally, in 1870, we find M.M. Vulpian and Hayemf 
reading before the Academie de Medecine of Paris a paper on 
this subject, supporting the views of these authors. Among 
the French micrographers, Lortet,| and Kanvier,|| had already 
entertained the same views. 
The transudation of the white corpuscles of the blood, through 
the parietes of their blood-vessels, is now a recognized fact, and 
it is admitted by many, that it is solely to this transudation that 
is due the formation of pus. 
Physiology has long ago taught us that, the white corpuscles 
of the blood were endowed with a movement, sui generis, called 
amoeboid movement. Lortet has proven that it was due to it, that 
the white corpuscles transuded through the parietes of their 
vessels. 
The transudation being known, as also its cause, the question 
now is, how to stop it. If we know not what the intimate cause 
of erysipelas is, let us at least deduct from its pathology, if we 
•can, a treatment. Such is the object of this paper. 
From the learned researches of authors, and in particular those 
of Dr. Binz,§ we have been taught that quinine had the power 
of stopping the amoeboid movement of the white corpuscles of 
the blood. It was with the neutral muriate of quinine that the 
doctor made his experiments, as it is the most soluble of the 
quinine salts, dissolving in 60 times its volume of water. The 
object of those researches was to prove that quinine possessed 
antiseptic properties. Admitting that the works of MM. Schultze, 
Schwann, Pasteur, and many others, are correct, he admits, a 
priori, that the animalcules developed in putrefied liquids are 
the cause of the chemical modifications which take place in these 
liquids. In proving the powerful toxic effect of quinine on the 
inferior organisms, he has established the antiseptic properties of 
this drug. 
* Journal de 1’Anatomic et de la Pliysiologie de Robin, 1867. 
-j- Academie de Medecine, seance du 15 fevrier, 1870 
I Lortet—Annales de la Societie des Sciences Medicales de Lyon, 1868. 
|| Ranvier—Com ptes rendus de la Societie de Biologie, 1868. 
$ Experimentelle Untersuchungen uber das Wesen der Chinimvirckung, von Dr. C. 
Binz (Experimental Researches on the modus operandi of Quinine, by Dr. Binz, in 
Archives de Physiologic, 1868, p, 747. 1874] 
LeMonniek—Erysipelas: Sulphate of Quinine. 
311 
In order to obtain better results, be first experimented on (mi- 
croscopically speaking) infusoria; of a colossal size, namely, the 
parameeia and the colpoda, which are to be found in ATegetable 
infusions. Later, it was discovered that the vibrios and bacteria 
were also destroyed by quinine. 
A solution of muriate of quinine, one part to 800 of water, in- 
stantly kills the voluminous infusoria;. One part to 2000 kills 
them in a few minutes, and one part to 20,000 in a few hours. 
Such is the special action of quinine, which the other vegetable 
alkaloids do not possess to the same degree. A solution of sali- 
cine, of one part to forty of water, has no visible action on these 
animalcules. Muriate of morphine, one part to 120 of water, 
does not kill them completely in the space of one hour, titrate 
of strychnia, one part to 200 of water, only acts after a contact 
of a few minutes. 
Among the reagents which do not possess corrosive properties, 
liypermanganate of potash alone seems, in this respect, to be 
more powerful than quinine. Of the active chemical substances, 
the salts of copper and zinc, and also creosote, have a less ener- 
getic action. Bichloride of mercury alone seems to be equal to 
quinine. 
Among the smaller infusorise, the vibrios, spirilla, bacteria, 
are liable to the same results as the parameeia and colpoda. The 
monads seem to offer a greater resistance to the effects of the 
poison. In concluding, Dr. Binz says: “A solution of quinine 
sufficiently concentrated has a marked antiputrid action, and 
surpasses in this respect a number of substances whose conserva- 
tive powers have long since been recognized.” Here I fully agree 
with this distinguished physiologist, as I have often had the 
occasion of verifying this antiputrescent power of quinine. 
As regards the antiphlogistic properties of this drug, we shall 
see to what conclusions Dr. Binz comes, from the results of the 
researches above mentioned. 
“The spontaneous movements of the white blood corpuscles 
Avere first mentioned by Lieberkiihn, and later by Schultze. If 
to perfectly pure serum be added a drop of blood, taken from an 
animal in full digestion, Ave shall see the amoeboid movements. 
Let this experiment be repeated with serum containing 2(J00 part 
of quinine, and Ave shall see the inoATements of the Avhite cor- 
puscles stopped, whereas the red ones have not in the least been 
affected. 312 
Original Communications. 
[Xov. 
“Two young cats having taken each half an ounce of milk, one 
of them received several subcutaneous injections of quinine. 
Their blood was afterwards examined with the microscope. The 
white globules were seen to be greatly diminished in the blood 
of the one which had received the injection of the quinine. Be- 
fore the experiment, this animal showed a larger amount of white 
globules than the other (294 against 214); after the experiment 
he had twenty times less (17 against 344).” 
From this effect of quinine on the white corpuscles, the doctor 
concludes that quinine is an antiphlogistic. He admits with 
Conlieim, that in the majority of cases, inflammation is not char- 
acterized by a proliferation of the elements of the conjunctival 
tissue, but by an increase in the number of the leucocytes, and 
their issue through the vascular parietes, to scatter themselves 
in the surrounding tissues. Viewing things in this light, it is 
easy to understand the action of quinine on inflamed parts. 
From the numerous experiments, made especially on the batra- 
cians, and reported in the paper of Dr. Sebarrenbroich, Dr. Binz 
affirms that, subcutaneous injections of quinine delay the develop- 
ment of inflammations, and when their effects have had time to 
show themselves, cause them (the inflammations) to disappear. 
If quinine acts so powerfully against inflammatory affections, 
such as pyaemia, etc., how is it that we do not always obtain a 
success? To this Dr. Binz answers as follows: “This is due to 
two principal causes. First, the doses given are not large 
enough. To prescribe efficaciously against the progress of a 
peritonitis, in a subject weighing 150 lbs (the dose of the drug 
should evidently be in proportion to the mass of the individual) 
we must give from 12 to 15 grammes of quinine (3 to 3f drams) in 
24 hours. 
“Second, it frequently happens that a large portion of the drug 
is not absorbed. This is what often happens when .we make use 
of the sub-sulphate (or neutral sulphate) of quinine. This pow- 
der is often inert, and goes through the bowels without being 
absorbed.” For this last reason the author hopes that the muri- 
ate of quinine—a soluble salt, par excellence—will substitute the 
sulphate in daily practice. 
I believe that practitioners have exaggerated the fears of large 
doses of quinine, but yet I do not, for the present, advocate such 
large doses as advised by Dr. Binz, i. e., in proportion to the 
wreight of the individual. As to the second clause, the non- 1874] 
LeMonnier—Erysipelas: Sulphate of Quinine. 
oi o 
Olc> 
absorption of the drug, all practitioners have liad occasions to 
regret this. 
The great solubility of the muriate of quinine, and its easy in- 
troduction into the system by subcutaneous injection, should be 
a sufficient reason to give it the preference. Not only the 
chances for non-absorption by this method are less than by any 
other, but its action is more rapid. 
Concerning the doses of quinine, it will be seen that I gave 2 
grains every hour, then every 2 hours, 3 hours, and 3 times 
daily. The patients, except in a few instances, never taking 
their medicine regularly, which decreases the supposed dose of 
the kinick salt taken in the 24 hours. Others have prescribed 
with satisfaction the sulphate quinine in this disease, in doses of 
G or 8 grains in the 24 hours. Dr. Biuz, no doubt, according to 
his theories, would have prescribed larger ones than I have. 
Sum toto, this proves that the quinine is paramount, and the 
dose secondary. It is only by comparative statistics that we can 
know what is the proper quantity to be given. 
Another point of great interest is to continue the administra- 
tion of the remedy for several days, say one week, after all traces 
of the erysipelas have disappeared. If this rule is not strictly 
adhered to, relapses are most frequent (Cases 8 and 10). 
Few of the cases reported, as will be seen, have suffered from 
secondary abscesses, and in those who have, the abscesses have 
been insignificant. 
But one case proved fatal, and it was one of traumatic erysipe- 
las of the foot. I have had to contend against no serious acci- 
dent in those whose head was affected by the disease. No brain 
symptoms of any kind, though in one case, where the head and 
tace were affected, there were three relapses. 
Quinine was given as soon as the first symptom, initiatory chill 
or rapid rise of temperature, showed itself. In some cases the 
drug was prescribed before the appearance of the eruption. 
Except the case which terminated fatally, none offered those 
alarming symptoms which we so often have to battle against in 
the cases entering hospital in an advanced stage of the disease, 
in which no treatment, or an improper one, has been instituted 
prior to their admittance. No delirium, or if any, a very light 
one; no ataxo-adynamic symptoms; i\ot even any tendency to 
deep seated abscesses. I was told by my colleague of the hos-  
Original Communicai Ions. 
[Xov. 
pita], Dr. S. Logan, that several ot his cases had either had some 
deep seated abscesses or presented a tendency to their formation. 
Are these mild symptoms in the majority of my cases to be 
attributed to the treatment employed, quinine'? I think so. 1 
am not prepared to say whether quinine possesses a marked 
superiority over all other methods of treatment in this disease, 
as I have not inquired into the modus curandi of my colleagues 
at the hospital, but I may say, that in the hands of Dr. Per- 
roud,* of the the Hotel Dieu de Lyon, as also in mine, it has 
proved most valuable. 
Except a purgative now and then, when a marked saburral 
state of the tongue existed, or in cases accompanied with con- 
stipation, the kinick salt was the only treatment. Where the 
local heat was very great (as in Case 12), an evaporating lotion 
Avas prescribed, which was cooling and agreeable to the patient. 
Anything else that might have been ordered were placebos, 
calculated to quiet the patient’s mind, and not with any hope of 
a curative effect. 1 have little or no faith in the topical treat- 
ment, and depend on the constitutional one for a cure or allevi- 
ation. 
In several instances, it will be seen that I prescribed collodion 
loco dolenti. It was with a view of testing the abortive power of 
this topical agent in erysipelas. Dr. Paul Broca, Clnrurgien des 
Hopitaux de Paris, strongly recommends it, and recognizes its 
power in arresting the march of the exanthema when properly 
applied. Dr. B. is a high authority, and whatever he recom- 
mends deserves a trial. His method is to surround the affected 
parts, say half an inch beyond the line of demarcation, with a 
band of collodion, which, if properly kept up, will prevent the 
spread of the eruption. I have applied this method according 
to directions, and as I have seen it employed, in Paris, by M. 
Broca himself, and am sorry to say that, in every instance, the 
result has been a negative one. Why is this’? The Parisian 
surgeon reports cases of success. It does not behoove me, a 
young surgeon, to criticise the results of my former and time- 
honored teacher of the hospitals of Paris. Perhaps on a future 
occasion, with a more extensive experience, I will be better able 
to put forth an Opinion. 
Twelve cases of erysipelas are reported, which are divided as 
folloAvs: Idiopathic 2, Traumatic 10. They are subdivided as 
* Loc. cit. 1874] 
LeMonnier—Erysipelas: Sulphate of Quinine. 
315 
follows: Erysipelas of the face and head 5, trunk 4, superior ex- 
tremities 1, inferior extremities 2. The diatheses attached to 
these 12 cases are, alcoholism 3, syphilis 1, scrofula 1, tubercu- 
losis 1, none G—total 12. 
Two cases, Nos. 8 and 10, had each 3 relapses, i. e., new attacks 
of erysipelas returning after a complete disappearance of the 
eruption, from a too early discontinuance of the drug. Counting 
the relapses as so many cases, we have 1G cases, with 118 days 
as the sum of their duration, which gives 7£ days as the mean 
duration of each case. Five cases, Nos. 5, 6, 7, 11 and 12, had a 
shorter duration. 
Observations. 
Case 1.—Extensive syphilitic caiies and necrosis of right 
shoulder; intercurrent traumatic, erratic erysipelas; abscess of 
left side; syphilitic cephalsea. Cured. 
April 15th—Antecedents.—This man, aged 44 years, entered my 
ward on March 5tli, 1874, for an extensive caries and necrosis of 
right shoulder dating back four years. He has had syphilis in 
former days; has suffered for the last two months from a ceph- 
alsea, which nothing has relieved. Since his admittance, he has 
been taking 20 grains iodide potassium 3 times daily. His head- 
ache is gone and shoulder improving. 
Day before yesterday (13th) erysipelas having broken out in 
the ward, I advised him to leave and come back again in a few 
days, when the disease would have disappeared. I feared he 
might catch it, which would be serious on account of the extent 
of the injury and his bad state of health. He left that day but 
came back the next morning (14th), with the intention of re- 
maining in the hospital. I again warned him against exposing 
himself to the exanthema, but he insisted upon remaining. 
Present Condition.—This morning he has an extensive erysipe- 
las of right shoulder, arm, and corresponding half of back at its 
scapular region. The arm is very much swollen and painful 
from the shoulder down to the hand inclusively. The erysipela- 
tous parts are covered with phlyctsenae from the size of a small 
pea to that of a twenty-five cent piece. Pulse 72; temperature 
101° V. Tongue good. 
R—2 grains sulphate quinine every hour. Encircle parts with 31G 
Original Communications. 
[Nov. 
collodion, to stop if possible the march of erysipelas. Continue 
iodide potassium. Diet ad libitum. 
April lGth. Feels better. Exanthema fades where it first 
broke out and progresses in the opposite direction, in spite of the 
circle of collodion. A concentrated solution of tannin w hich had 
been applied to affected parts (placebo) is this day discontinued. 
Pulse 102; temperature 101° l1. Tongue good; bowels regular; 
arm very much swollen. Continue quinine. 
April 17th. Erysipelas advances on the sound parts, and is 
now reaching the left side of chest and base of posterior part of 
scalp. Swelling of arm decreasing. Pulse 72 (slow); tempera- 
ture 100° 77. Tongue good. Stop application of collodion; con- 
tinue quinine and pot. iod. 
April 18th. Swelling of arm going down. Erysipelas has 
reached left side of body and is descending. Here, over angles 
of 8th, 9th and 10th ribs, is a swelling, size of one’s hand, longi- 
tudinal to the ribs, which seems to fluctuate; this is covered 
over with the eruption. Patient reports having had this lump 
several times. It comes and goes without anything being done. 
Pulse 72, slow7; temperature 102° 5'. Tongue good; no appetite; 
bowrels regular. Treatment as yesterday. 
April 19th. March of erysipelas continuing. Swelling of left 
side disappears. Pulse 84; temperature 103°. Tongue good. 
Same treatment. 
April 20th. Erysipelas principally over scalp and upper por- 
tion of forehead; almost gone from the trunk. Forearm, and 
hand, right side, very cedematous (impediment to venous circula- 
tion). Pulse very weak; temperature 99° 6'. Bowels costive. 
Same treatment. 
April 21st. Erysipelas over both temporal regions. Pulse 72; 
temperature 99° 3'. Tongue good; bowels operated upon. Same 
treatment. 
April 22d. Erysipelas disappearing fast. Pulse G6, slow7 
(kiuick); temperature 97° 5'. Tongue good; bowrels regular. 
R—2 grains sulphate quinine every 2 hours; continue syphilitic 
treatment. '• 
April 23d. Small patch of erysipelas over right malar bone. 
Swelling of hand and forearm almost gone. Pulse GO; tempera- 
ture 96° 8'. Take quinine every 3 hours; keep hand elevated. 
April 24th. Patch of erysipelas over right malar bone, size of 1874] 
LeMonnier—Erysipelas: Sulphate of Quinine. 
317 
a twenty-five cent piece. Pnlse 68; temperature 97° o7. Tongue 
very good; patient much better. Continue. 
April 25th. Patch of erysipelas over right malar bone slowly 
disappearing. Pulse 68, weak; temperature 97° 2'. R—Tinct. 
cinch, comp., .$vj; ferri citratis, sj. Tfi. S. Tablespoonful3 times 
daily. Continue potassi iodidi. 
April 26th. Improving. Pulse 72; temperature 98. Same 
treatment. 
April 27th. Right arm still swollen and cold. This swelling 
came after the disappearance of the erysipelas on this limb. 
Pulse 78; temperature 101° P. Same treatment. 
April 28th. Pulse 74; temperature 99° 3'. 
April 29th. All traces of erysipelas gone. Pulse 86; tempera- 
ture 99J. Tongue good. Treatment same. Duration of exan- 
thema 14 days; syphilitic lesions improving. 
Remarks.—My present intentions being to write on erysipelas, I 
here stop my observations in this case. The reader will at once 
see that the twTo affections traveled side by side without seemingly 
influencing each other. 1 have said nothing of the nature of the 
lesions of the right shoulder, from the fact that 1 did not notice 
any change in these parts which could have been attributed to 
the effects of the exanthema. Both treatments—internal for the 
erysipelas, and internal and external for the syphilitic diathe- 
sis—were kept up during the 14 days that the eruption lasted. 
No serious symptom of any kind showed itself during this lapse 
of time, although the patient was in a very bad state of health 
from a long continued (4 years) disease. 
I will here state that the threatened abscess of the left side 
did come and go, without any special treatment, as it is reported 
by the patient to have done, on several former occasions. Twenty- 
four hours after all traces of erysipelas had disappeared, i. e., 
when the patient was cured, and several days after the disappear- 
ance ot the eruption from the left side of body, the tumor again 
reappeared. This time it fluctuated and liacyinally to be opened. 
What was its origin I know not. I caries of one of the 
ribs, but my probe could discover none. At all events, while 
the erysipelas lasted, the lesions of the right shoulder and the 
general health, in a syphilitic point of view, nevertheless irn* 
proved. The abscess, as proven above, depended on this dia* 
thesis, and was not caused by the erysipelas. 31S 
Original Communications. 
[Nov. 
This patient is to-day (June 24th) cured, and will leave the 
hospital at the end of the month. 
Now, to what is due the mildness of this erysipelas in a patient 
with such a dilapidated constitution? Is it not rational to think 
that it is due to the treatment instituted? 
Case 2.—Traumatic erysipelas of right hand. Cured. 
March 31st, 1874. James Rooney, aet. 28 years, native of 
England, in America 3 years, stonecutter. Entered my ward 
on the 27th of March (erysipelas was then in the ward), for 
necrosis of some of the bones of the right hand, the result 
of an accident produced by a circular saw some two months pre- 
vious. Yesterday, at about 2 p. m., he was suddenly taken with 
a “strong chill, lasting about 3 hours” (sic.), “followed by fever.” 
Present Condition.—Pulse 72; temperature 99° 5 . Commenc- 
ing erysipelas at seat of injury; wounds look bad. Previous to 
this the injured parts looked well. Bowels regular; patient ema- 
ciated: this he reports as the consequence of his injuries, as pre- 
viously he enjoyed good health. Removed another sequestrum. 
R—Quiuue sulphatis, 2 grains every hour Patient not to be 
disturbed when asleep. Charpie 1. d. 
April 1st. Pulse 116; temperature 105° S'. Erysipelas has 
extended to the whole surface of the hand and is progressing up 
the forearm. Along the dorsal surface of the latter, reaching up 
almost to the elbow, is an irregular reddish line of angioleucitis. 
Local heat great; bowels regular; tongue pointed and dry. No 
pains of any kind at either hepatic or other regions. Continue 
quinine. Tinct. arnica and water aa locally. Above elbow, arm 
encircled with collodion to check, if possible, the march of the 
exanthema. 
April 2d. Pulse 80; temperature 101° 1'. Greatly improved. 
Erysipelas seems stationary. Extracted one piece of bone from 
lirst metacarpal. Continue treatment. 
April 3d. Pulse 90; temperature 103" O'. Erysipelas station- 
ary; has not overstepped the band of collodion. Tongue poiuted 
and reddish; bowels regular. Continue. 
April 4th. Pulse 94; temperature 102° o'. Tongue pointed 
and good. Threatened abscess of dorsal surfaces of hand and 
wrist. A few small pieces of bone come out with the dressing. 
Erysipelas has ascended above the band of collodion. Same 
treatment continued. 1874] 
LeMonnier—Erysipelas: Sulphate of Quinine. 
319 
April 5th. Pulse 84, slow; temperature 101° 3;. Tongue 
good. Abscess has opened and discharged pus through one of 
the wounds. Erysipelas fading. Continue. 
April 6th. Pulse 96; temperature 103°. Tongue pointed, with 
tip and edges red. Erysipelas ascending the arm; phlegmonous 
inflammation of hand. Extracted a few spiculae ot bones; wounds 
look bad. Continue quinine; stop collodion. 
April 7th. Pulse 84; temperature 99° 7'. Crepitation of ne- 
crosed bones being very distinct, suppuration abundant and un- 
healthy, the removal of the former is decided upon. Patient is 
chloroformed; Esmarch’s method employed. The necrosis in- 
volves most of the bones of the wrist. The index finger is ampu- 
tated at its metacarpo phalangeal articulation; a portion of its 
metacarpal bone, at carpal extremity, is resected; metacarpo- 
phalangeal articulation of middle finger crepitates; ulna at radio- 
carpal articulation partially dislocated. After the operation 3 
drainage tubes are placed; two perforate the wrist, and one lies 
longitudinally over metacarpal space of index finger. The 
operation lasted 40 miuutes and was bloodless. Erysipelas is 
fading. 
B—Sulphate morphine (q. s.) to relieve pain. Continue qui- 
nine; continued irrigation with carbolic acid to Oj) water. 
Best diet. 
April 8th. Pulse 80; temperature 100° 4'. Tongue good; ery- 
sipelas disappearing; patient doing very well. Same treatment. 
April 9th. Pulse 72; temperature 99°. Doing well; bowels 
costive. Continue quinine and continued irrigatron. Castor oil 
5j to be taken in the morning. 
April 11th. Pulse 70; temperature 99°. All traces of erysipe- 
las have disappeared. 
It—Tinct. cinch, comp, gvj, ferri cit. gi. TTf. Tablespoonful 3 
times daily. 
Duration 11 days. 
This patient is still in my ward, but his hand is saved, his 
final cure being but a question of time. From the critical con- 
dition of this hand at the time the erysipelas broke out, I had 
reasons to apprehend a serious result. Its (the erysipelas) effect 
was to rouse up a chronic inflammation to an active one, and 
force on my part an interference which I would certainly have 
delayed until the eruption had disappeared. This was a gain of 
time. 1 operated while the exanthema existed, and no recrudes- 320 
Original Com mu nications. 
[Nov. 
cence occurred. But the administration of quinine was kept up 
regularly, and to it is this no doubt due, as also the weakness 
of the traumatic fever subsequent to the operation. 
As will be seen, I thought at one time I was about having a 
success in the arrest of the erysipelas by the local application of 
collodion, but it was a delusive hope of onhT 48 hours. 
Case 3. Traumatic erysipelas. Sulphate quinine. Cured. 
April 21st. Albino M. Peralta, aet. 40 years, baker, entered 
my ward April 19th, 1874, suffering from a fistule of the anus. 
He was operated upon on day of admittance, by incision. Last 
night he had fever, and to-day an erysipelas exists at seat of 
injury. 
Present Condition.—Pulse 102; temperature 104°. Diffused and 
spreading inflammation of the skin around the seat of wound. 
Patient has no appetite. Headache. 
B—Sulph. quinine 2 grains every hour. 
Evening. Pulse 100; temperature 104° 3'. 
April 22d. Pulse 90; temperature 102° 5'. Inflammation of 
skin continues to spread in all directions. Tongue furred; head- 
ache; no appetite. Continue quinine. 
Evening. Pulse 100; temperature 104c 7 . 
April 23d. Pulse 92; temperature 103° 2. Erysipelas still 
progressing. Patient had no sleep last night. Tongue swollen 
and thick, furred in the centre, red. at edges. Same treatment. 
Evening. Pulse 92; temperature 104°. 
April 24th—Evening. Pulse 90; temperature 103° 2'. Patient 
better. Inflammation of skin disappearing; erysipelatous parts 
covered with phlyctenm. Continue quinine. 
April 25th. Pulse 80; temperature 101° 4'. Erysipelas dis- 
appearing. Patient better. Liquid from phlyctenm examined 
under the microscope and seen to be an exudation of white blood 
corpuscles. Continue quinine. 
Evening. Pulse 90; temperature 100° 7 . 
April 26th. Pulse 76; temperature 100° 1. Exanthema still 
disappearing. Tongue red. Same treatment. 
Evening. Pulse 100; temperature 104°. Patient not well this 
evening. Pulse strong and frequent. 
April 27th. Pulse 74; temperature 100° 7'. Feels much bet- 
ter. Erysipelas fades where it first showed itself, and descends 
iu au opposite direction. 1874] 
LeMonnier—Erysipelas: Sulphate of Quinine. 
321 
Evening. Pulse 86; temperature 102° 2'. Continue quinine. 
May 1st, Pulse 68; temperature 98° 2 . Bowels costive; in- 
flammation of skin descends along left leg; patient otherwise 
well. R—Pil. cath. comp. No. 4. S. 2 at once; others 4 hours 
after if not purged. 
Evening. Pulse 80; temperature 102° 2'. 
May 2d. Pulse 68; temperature 98° 2'. Erysipelas has reached 
the knee and is fading. Continue quinine. 
May 4th. Pulse 68; temperature 97° 7'. Exanthema gone. 
R—2 grains quinine every 2 hours. 
May 5th. Both constitutional and local symptoms have dis- 
appeared. Patient weak. R—Sulph. quinine 2 grains 3 times 
daily. 
May 9th. Patient cured of his erysipelas and almost cured of 
his fistule is, though weak and anaemic, at his request discharged. 
R—Ferrated cinchona wine. 
Duration 13 days. 
Remarks.—In favor of the theory which considers erysipelas as 
the result of a transudation of the white corpuscles through the 
parietes of the blood-vessels, we have the microscopic examina- 
tion of the 25th April, when the liquid contained in the phlyc- 
tenae was seen to be composed of white corpuscles. No amoeboid 
movements were seen. We account for their absence, when we 
remember that these corpuscles were not, when removed, in their 
proper channels, and consequently must have undergone changes 
affecting their ordinary movement. 
The exanthema was of a light inflammatory type. Its conta- 
gion is here plainly seen. A case in the adjoining bed, with the 
same surgeon, students and nurse, instruments, &c., attending 
on both. For what we know the same basin and sponge might 
have been used for each patient. Its incubation was of 48 hours 
duration; its starting point the wound. Fever most probably 
preceded the eruption, setting in with a high temperature, which 
reached its acme on the evening of the 2d day, with a morning 
remission, after which defervescence commenced. The evening 
rise and morning fall were well marked, until the total disappear- 
ance of the eruption, when the ascents ceased. No premonitory 
chill ushered in this erysipelas. No gastric symptoms accompa- 
nied it. Effects of quinine, dizziness, etc., but moderately 
marked, though the patient, the first 2 or 3 days, took regularly 
2 grains every hour. 322 
Original Communications. 
[Xov. 
Case 4.—Idiopathic erysipelas of head and face. Alcoholism- 
Cured. 
Thomas Flemming, aet. 33 years, Dative of Ireland, laborer, 
entered ward 3, Charity Hospital, May 3d, 1872. 
May 3d—Antecedents.—This man came here on foot. He is an 
alcoholic. Is unable to tell when he was first taken sick, but 
thinks his sickness dates back 5 or G days. 
Present State.—The swollen condition of his head and face at- 
tracted my attention These parts were (Edematous, swollen, 
red, sensitive to the touch, with a high temperature. There 
existed no injury of the head. The patient thought the swelling 
was caused by poisonous vines, of which there were many where 
he had been at work. I diagnosed an “idiopathic erysipelas.” 
His breath was offensive; mind clear; temperature very high, 
107° 2'; pulse 98, regular. Circumference of head 25 inches. 
R—Quinine 2 grains every hour; sulph. morphine or hydt. 
chloral q. s. at bed-time to procure sleep. Nourishment ad libi- 
tum. Best in bed. 
May 9th. Erysipelas increased for several days, then seemed 
to decrease, but to-day there exists a recrudescence of the exan- 
thema on the right cheek, with high temperature (104°), and 
rapid pulse, (104). Bowels constipated. His eyes were closed 
by the tumefaction of the lids, and the conjunctiva? blood shot. 
R—Continue treatment; purgatives. 
May 19th. Up to this day the symptoms of alcoholism have 
been more or less marked, inc.easing by night. Conjunctive, 
up to about the 15th day cf disease, being often blood-shot. 
The tongue at the height of the sickness dry, red and cracked. 
Delirium was so intense, that for several days and nights he 
had to be strapped to his bed. Costiveness very great, for 
which active purgatives were freely ordered. In the meanwhile, 
erysipelas followed suit to these symptoms—one day better, the 
next worse. To-day it has disappeared entirely, the fever is 
abated, and the circumference of the head has fallen to 22 
inches. 
Stop quinine. Comp, tinct. cinchona by tablespoonful 3 times 
daily. Best nourishment. 
Subsequent to this; secondary (metastatic!) abscesses formed 
under the scalp; but these not being the subject of this paper, 
suffice it to say that, from this day, all symptoms of erysipelas 1874] 
LeMonniee—Erysipelas: Sulphate of Quinine. 
323 
disappeared, and that the man left the hospital cared on the 
15th day of June, 1872. 
Duration of erysipelas 1G days. 
Resume.—An idiopathic erysipelas of head and face, with bili- 
ous complication, as evinced by the saburral state of the tongue. 
Subsequent to this, well marked symptoms of alcoholism set in, 
as epiphenomena, which, for a time being, overruled those of the 
erysipelas, and were treated by sulpli. morphine, as much as one 
grain in the night, and hydrate of chloral which, on one occasion, 
was given in a sij dose. As the patient improved, these doses 
were diminished, and finally the medicines stopped. 
Sulphate quinine in 2 grains doses every hour, as an anti- 
zymotic, was prescribed against the erysipelas. The bilious state 
of the primse vise was combatted by appropriate purgatives— 
calomel and bicarb, soda, castor oil, and the neutral salts. These 
acting besides as a derivative of the cerebral circulation. No 
local applications. 
Case 5.—Thos. Conway, aet. 42 years, Irishman, laborer, entered 
my ward April 16th, 1872. Discharged cured, May 7th, 1872. Di- 
agnosis—traumatic erysipelas of head and face. Entered hospital 
on fifth day of disease. On first day of treatment, sixth of sick- 
ness, temperature 104° 9'; 2J day, 104° 5'; 3d day, 194° 4;. On 
the 4th day after admittance, he was without fever. For the first 
three days he was delirious at night. Treatment consisted in 
1 grain doses of sulphate ot quinine every hour (patient not to 
be disturbed when asleep) and narcotics at night. On the 20th 
he took a dose of castor oil. From this day all treatment ceases. 
On April 24th abscess of superior right eyelid lanced. 
On day of admittance, and the following 3 or 4 days, his breath 
was of a peculiarly offensive smell. He had a diarrhoea, for 
which no treatment was instituted. He could not tell how' the 
disease commenced. He is an alcoholic. 
Erysipelas cured after 4 days of treatment. 
Case 6.—Eicardo Barbaso, Mexican, aet. 30 years, entered May 
5th, 1873, for scrofulous necrosis—intercurrent traumatic erysipe- 
las. For the diathesis, cod-liver oil and comp, tinct. cinch, aa, 
were prescribed, and for the erysipelas 2 grains sulph. quinine 
every hour. On the 4th day the latter was cured. 
Duration 4 days. 324 
Original Communications. 
|Xov. 
Cise 7.—Traumatic erysipelas. Peter Fahey, aet. 36 years, 
entered ward 8, Charity Hospital, April 20th, 1874, for a stricture 
of rectum. On May 1st, subsequent to manipulations for gradual 
dilatation of stricture, an erysipelas of anus broke out which, oil 
the 3d had reached the scrotum, where an abscess ot its cellular 
tissue had to be lanced on the 7th. He was put on the quinine 
treatment, 2 grains every hour, then 3 times daily. On the 9th, 
all traces of erysipelas had disappeared, and on the 11th quinine 
was stopped. Patient recovered. 
Duration 6 days. 
Case 8.—Traumatic erysipelas, complicated with alcoholism. 
John Donovan, aet. 25 years, Irish, sailor, entered ward 8, 
April 15th, 1874. Discharged, on his demand, May 14th, 1874. 
This man was an alcoholic. When he entered my ward, his face 
and head were very much swollen from a traumatic(?) erysipelas. 
We supposed it to be of a traumatic origin from the fact that two 
days after his admittance a small wound of the scalp was dis' 
covered. Delirium at night during the first 3-4 days, which 
necessitated the administration of morphine, lie could not say 
when he was first taken sick. He was put on the usual quinine 
treatment, two grains every hour, then every two hours, and 
finally 3 times daily. On April 20th, 10 grains each calomel and 
bicarb, soda were successfully prescribed for a constipation ac- 
companied with a bilious tongue. On the 22d, an abscess of 
the right upper eyelid was lanced. There being then no more 
traces of erysipelas quinine was stopped, but had to be admin- 
istered two days later (24th), for a relapse of the exanthema. 
May 1st—appetite being wanting, pulse small and weak, comp, 
tinct. cinch. (3SS. 3 times daily) was ordered. May 5tli—lanced 
abscess on left side of lower jaw, where no traces of erysipelas 
had existed. This shows the similarity between this disease and 
pyaemia, as regards the formation of metastatic abscesses. May 
11th—all traces of erysipelas having again disappeared since 
3-4 days, after having attacked different portions of the face 
and head, general health being ameliorated, quinine was again 
stopped. Two days later, a third attack of the exanthema, 
milder than the preceding one, quinine again prescribed. When 
he left on the 14th (to go to Marine Hospital), a trace of erysipe- 
las still existed at the root of the nose and adjacent parts. 
This case shows the necessity of continuing the quinine treat- 1874J 
LeMonnier—Erysipelas: Sulphate of Quinine. 
325 
ment several days after all traces of the erysipelas have disap 
peared. The first attack was cured in less than 7 days. The 
second, is of an erratic and mild type, and lasted 14 days. When 
he left, he bore a trace of the fid attack, which had commenced 
24 hours previously. Despite the symptoms of alcoholism, espe- 
cially marked at night, this case proved a mild one. 
Case 9.—Traumatic erysipelas. Cured. 
Mary Newes, aet. 17 yrs, Ward 36, Charity Hospital. Through 
the courtesy of my colleague, Dr. Alexander Hart, 1 was asked 
to operate on this young girl on the 12th of May, 1874. The fol- 
lowing day she had fever, preceded by a chill, and followed by 
an erysipelas at the seat of injury. The operation was long, 
and necessitated the use of a large amount of chloroform, 
which caused an irritability of the stomach. 
May 13th. Erysipelatous inflammation around seat of wound. 
Irritable stomach. 
R—2 grains sulph. quinine every hour, when not asleep. 
May 14th. Erysipelas increased, accompanied with irritable 
stomach and phlyctense. No medicine could be retained. Con- 
tinue quinine. Carbolic acid wash &j to Oj., 1. d. 
May 15th. Erysipelas still progresses. Irritability of stomach 
continues; rejects all that she takes. Continue quinine and car- 
bolic acid wrash. R—Sulph. morphine q. s., to quiet stomach. 
May 18th. Erysipelas descends along the leg. Irritable stomach 
continues. Costiveness. Pulse small and weak. Tongue red 
and dry at centre, white at the edges. Irritability of stomach 
prevents the ingestion of food or medicines. 
R—Pil. catln comp. No. 4, to be followed by salt and water 
enema if necessary. Morphise sulph. grij, into 12 papers. S. One 
p. r. n., to quiet stomach. Continue quinine. Tinct. cinch, 
comp. 3ss3 times daily. Carbolic wash, 1. d. 
May 19th. Erysipelas descends along the leg. Bowels cos- 
tive. Stomach is so irritable that nothing is retained. R—Hypo- 
dermic injection of sulph morphise (£ grain) at epigastric region. 
Comp, tinct. cinch, and carbolic acid wash l.d., as before. Salt 
and water enema. Discontinue quinine. 
May 21st. Tongue clean. Stomach no longer irritable. Ery- 
sipelas has reached the knee. Patient craves for acids. Con- 
tinue coinp. tinct. cinch, and local treatment to wound. 326 
Original Communications. 
[Nov. 
May 25th. Exanthema has readied the foot. Found patient 
eating ham and mustard. 
Continue the same treatment. 
May 27tli. Foot (Edematous. No more erysipelas. Threaten- 
ing abscess on dorsal surface of foot. Same treatment. Poul- 
tice to foot. 
May 28th. The most pointing part of the swelling lanced. A 
serous liquid escaped. Same treatment. 
May 29th. Foot doing well. Furfuraceous desquamation of 
those parts of the skin attacked by the erysipelas. 
Remarks.—This girl was considered by many as a “gone case.’7 
Except the sick stomach, I do not see that any troublesome 
symptoms accompanied the erysipelas. But for the gastric irri- 
tability, caused by the chloroform, which prevented the ingestion 
of drugs, the exanthema would have ended sooner. At no time 
did my student, Mr. Deslattes, or myself ever doubt a success- 
ful result. 
Duration IT days. 
Case 10. Erratic traumatic erysipelas of head and face recur- 
ring three times. Cured. 
Laurent Duchenue, ®t. 41, Frenchman, milkman. Entered 
Charity Hospital, February 21st, 1874. Discharged cured, 
May 17 th, 1874. 
March 12th—Antecedents—This man entered my ward on the 
21st of February for an extensive injury of the head. While 
driving his cart, at 1 a.in., he fell, the wheel passing over his 
head, denuding the skull of its scalp on the anterior right side 
and posterior left side. Here was a lacerated wound of the 
scalp, semicircular in shape, 8 inches in length, below and to the 
left of the occipital protuberauce. In front, at an inch (?) to 
the right of the median line, on the top of the head, was another 
lacerated wound of the scalp, eleven inches in length, extending 
from the occipital bone to the inner angle of the right eye, partially 
tearing off the superior lid. The whole of that side of the skull was 
denuded of its scalp, which hung over the right ear. At the parie- 
tal protuberance a portion of the periosteum, of a circular shape, 
about 2 inches in diameter, was torn off, adhering to the scalp. 
The supra orbital nerve was partially lacerated. 
The wounds were dressed, secundum artem, the posterior heal- 
ing by first intention, the anterior by first and second intentions. 1874] 
LeMonniek—jErysipelas: Sulphate of Quinine. 
327 
The wound was healing kindly when on this day erysipelas is 
discovered. 
Present Condition.—Pulse 96 ; temperature 102°2/. Commenc- 
ing erysipelas on right anterior side of head and right superior 
eyelid. No precursory chill has ushered in this exanthema. 
Tongue good. Appetite poor. 
R—2 grains sulph. quinine every hour. Not to be disturbed 
when asleep. Encircle erysipelatous patch with collodion. Con- 
tinue local treatment. 
March 13th. Pulse 92 ; temperature 101°4. A11 abscess of right 
superior eyelid has opened at inner angle of eye and runs freely. 
Erysipelatous inflammation about gone. Bowels regular. Con- 
tinue treatment. 
March 14th. Pulse 72; temperature 101°4. Doing quite well; 
all traces of erysipelas gone. Local treatment. 
March 16th. Pulse 120; temperature Tongue good. 
Wounds look bad ; will probably have erysipelas. No operation 
from bowels. R— Pil. catli. comp. No. 8. S. 4 at once. If not 
purged by morning, give the other four. Continue local treat- 
ment. 
March 17tli. Pulse 86; temperature 100°. Very light erysipe- 
las at seat of injury, at occipital region. Three operations from 
bowels. Took 8 pills. 
March 18th. Pulse 84; temperature 100° P. Doing better. 
March 19th. Pulse 102; temperature 101c 4 . Not very well; 
no appetite. Wound doing well. R—Tinct. cinch, comp., avj, 
tablespoonful 3 times daily. 
March 20tli. Pulse 72, weak; temperature 103° G'. Tongue 
saburral. No appetite. Feels weak. Erysipelas of right supe- 
rior eyelid and corresponding side of head; horripilations. Con- 
tinue tinct. cinch. 
March 21st. Pulse 108; temperature 106° 3'. Tongue furred 
and trembling. Horripilations. Bowels regular. Two large 
phlycten® at erysipelatous spot on right side of forehead. 
R—2 grains quiuine every hour. Continue comp, tinct. cinch. 
March 22d. Pulse 108; temperature 104° 7'. Tongue cleaner. 
Bowels loose, 7 operations. Wound doing better. Erysipelas 
on left side of forehead. Horripilations. Continue medicine. 
March 23d. Pulse 82; temperature 102° 2'. Much better. 
Erysipelas over nose and right ear. 2 grains quinine every 3 
hours. Original Communications. 
[Hov. 
328 
March 24th Pulse 102; temperature 104° 3'. Erysipelas on 
left side of face and ear. Wound better. Quinine, 2 grains 
every hour. 
March 25th. Pulse 90; temperature 96° 8'. Much better. 
Continue quinine. 
March 28th. Pulse 78; temperature 993 3 . No more erysipe- 
las. Stop quinine. 
March 29th. Pulse 120; temperature 105° 4'. Erysipelas lias 
again broken out on right side of forehead. Tongue furred, with 
a tendency to become dry. Pus of wounds unhealthy. 
R—2 grains sulph. quinine every hour. Continue local treat- 
ment. 
March 30th Pulse 100; temperature 104° 3'. Erysipelas over 
right side of bice and forehead. Continue treatment. 
March 31st. Pulse 90; temperature 100° 1. Improving. Con- 
tinue treatment. 
April 3d. Pulse 78; temperature 96° 8'. Much better. Sulph. 
quinine, 2 grains every 3 hours. 
April 5th. Pulse 84; temperature 99° 5'. No more erysipelas. 
April 7tli. Doing very well. Lanced abscess over eyelid. 
April 8th: Improving. Appetite very good. Scalp adhering 
to bone. 
April 20th. Improving rapidly. 
May 8th. Leaves hospital to-day, though his wound is not 
entirely healed up, on account of the erysipelas which prevails 
here. He has now been without the distemper for over a month, 
Duration 25 days. 
Remarks.—By carefully reading this case one cannot fail to see 
the marked effects of quinine on the march of erysipelas, on 
the pulse, on the temperature, and the necessity of continu- 
ing the drug for several days after all traces of the exanthema 
have disappeared. If this precaution be not strictly adhered to, 
the eruption soon returns, as it did here on three different occa- 
sions. I look upon this case as a typical one, to prove the good 
results to be obtained from the administration of the kinick salts 
in this disease. The erysipelas is seen to disappear rapidly under 
the use of this drug, and reappear if it be too soon discontinued. 
The pulse and temperature are seen to fall uuder its use. This 
fall will be accounted for further on. 
Case 11.—Idiopathic erysipelas of face. 1874] 
LeMonnier—Erysipelas: Sulphate of Quinine. 
329 
William Bass, aet. 40 years, carpenter, Missourian, entered my 
ward on the lOtli December, 1873. Antecedents.—Patient entered 
hospital for a stricture of urethra, for which external urethrotomy 
was performed on February 28th, 1874. On the 11th day after 
operation, whereas the wound of perineum was doing very well, 
with rosy granulations and healthy pus, as testified by my friend 
Dr. Castellanos, an idiopathic erysipelas of face broke out. 
This patient is of a tuberculous constitution. 
March 10—Present Condition.—Pulse 120; temperature 102° 5'. 
Tongue dry. Did not sleep on account of pain in the tace. Ery- 
sipelas over the left malar bone and the nose. 
&—2 grains quinine every hour. 
March lltli. Pulse 108; temperature 102°. Tongue good. 
Bowels loose. Passed a restless night. Erysipelas disappearing 
on one side of the tace, commencing on the other. 
R—Quin, sulph. 7)ijss. aeidi sulph. q. s.; tinct. opii aq. sxii. 
111. S.—Tablespoonful every hour. 
March 12th. Pulse 108; temperature 101° 3'. Tongue very 
good. Erysipelas disappearing. Continue medicine. 
March 13th. Pulse 114, very small and weak; temperature 
98° 2'; respiration 20, normal. Profuse hemorrhage from lungs 
yesterday at 4 p. m., for which 20 drops muriated tinct. of iron, 
every hour, was prescribed by the assistant house surgeon. The 
erysipelas has disappeared. Tongue moist and anaemic. Peri- 
neal wound doing well. 
R—20 drops Tinct. iron to-night R—Olei morrhuoe, tinct. cinch, 
comp, aa: tablespoonlul 3 times daily. 
March 14th. Pulse 116, weak, rapid, small; temperature 101° 8 , 
Tongue good. Pains in both sides of face (probably a return of 
the erysipelas). Wound of perineum and scrotum does not look 
well. Stop medicines. Take 2 grains quinine every hour. 
March 15th. In statu quo. Pulse 120; temperature 103° 2'. 
Continue quinine. 
March 16th. Better. Pulse 104; temperature 100" 7'. R—Olei 
Morrhum, tinct. cinch, comp. aa. By tablespoouful 3 times 
daily. From this day no more fears of erysipelas. 
Duration 4 days. 
Remarks.—The appearance of an idiopathic erysipelas of the 
face, where not a scratch existed, in one with an extensive wound 
of perineum and scrotum (a portion of scrotum had gangrened 
away), shows that the cause of erysipelas is not dependent on 330 
Original Communications. 
[Nov. 
wounds. When it is associated with a wound it comes in as an 
epiphenomenon, and should be treated as such. It may be so 
serious as to become, tor a time being, the principal affection, 
and in fact cause death, as was the case in the following obser- 
vation. 
Case 12.—Traumatic erysipelas of foot. Ataxic symptoms. 
Death. Necroscopy. 
April 1st—Antecedents.—Charles Hoffmann, act. 27 years, 
sailor, entered my ward, bed 14, March 24th, 1874. Eight days 
previous to admittance, cut his foot with an axe. Hemorrhage 
copious at time of accident. The dressing was removed for the 
first time the day after his admittance to the hospital. No union 
of wound, which was very dirty with blood and soot (the lath r 
had been applied by the patient at time of accident). The in- 
cision was ou the track of the dorsal artery of the foot, crossing 
it very obliquely at the first interosseous space where, at the 
metatarso-phalangeal articulation, the artery was cut. The pul- 
sations which were distinctly felt at the cardiac end, were ab- 
sent at the distal end. A strip of plaster was loosely placed 
across the injury, which was about 1£ iuches in length, and its 
lips approximated. Forty-eight hours after this dressing, a 
secondary hemorrhage took place. I removed the dressings, which 
had been placed pro tempore by the student, and no hemorrhage 
followed. The pulsations at the cardiac end were visible, A bit 
of lint folded up, placed on the track of the artery, one inch above 
the cut and kept iu place by a strip of sticking plaster, which en- 
circled the foot, completely stopped the pulsations below. Forty- 
eight hours after, though the pressure above was still kept up, 
pulsations had returned below. Besides a small puftiness existed 
at the seat of injury. A stronger pressure on the dorsal artery 
diminished these pulsations, but did not stop them. It was evi- 
dent that a communication existed at the distal eud. This was 
with the plantar arch, through the communicating artery. A 
diffused traumatic aneurism between the latter and the dorsal 
arteries was forming. Pressure on both the posterior tibial and 
dorsal arteries, stopped the pulsations in the aneunsmal sac. 
Compression was kept on the dorsal, and a strip of sticking plas- 
ter over the wound and aneurism. The latter being very small, 
might disappear by the cicatrisation of the former. Another 
hemorrhage took place ou the following morning, March 30th. I 1874] 
LeMonnier—Erysipelas: Sulphate of Quinine. 
331 
then ligated the dorsalis pedis, an inch above the seat of injury, 
scooped out the blood from the aneurismal sac, and, unable to 
ligate the communicating artery, which was imbedded in the first 
interosseous space, I made the acupressure with one of Dr. J. Y. 
Simpson’s needles and according to his method. The bleeding 
was free and copious from the distal end, which necessitated the 
compression of the posterior tibial, by my assistant, Mr. Des- 
lattes. Acupressure needle removed next morning. No hemorr- 
hage. Patient anmmic. 
Yesterday morning, March 31st, when I removed the acupres- 
sure needle, fever was quite high. I neglected to take the tem- 
perature and count the pulse, which previous to this little oper- 
ation were normal. I did not then (yesterday) think that such, 
a trifling operation could cause such a high traumatic fever. 
This morning the cause is known—erysipelas. He 
the latter part of the night. Took a dose of oil yesterday. 
Present Condition.—Pulse 109; temperature 105° 4 . Tongue 
pointed, moist and aneemie. Thirst great. Oil operated twice. 
At seat of injury commencing erysipelas, spreading in all direc- 
tions. Wound looks bad. No hemorrhage. Local heat very 
high. No pains at either hepatic or other regions. 
R—Parts surrounded by collodion, to prevent, if possible, the 
exanthema from spreading. 2 grains sulph. quinine every hour. 
Tinct. arnica and water aa, loco-dolenti. 
April 2d. Pulse 110 ; temperature 106o5'. Tongue moist and 
anaemic. Horripilations. Bowels loose. Thirst very great. 
Erysipelas disappearing. R—Continue medicine. £ grain sulph. 
morphine every 3 hours. 
April 3d. Pulse 108, small and weak; temperature 104°3. 
Tongue pointed and very dirty. Bowels checked. Wound looks 
healthier. Eryripelas almost gone. Delirium during night. 
R—Continue quinine. Ferrated comp, tinct. cinch, by table- 
spoonful every hour. 
April 4th. Pulse 144, weak, rapid; temperature 105°4/; 
respiration 60. Tongue furred, white, and dryT. Hiccough since 
yesterday. Delirium. Wound dry. Erysipelas gone. No opera- 
tion from bowels since yesterday morning. Micturates freely. 
R—Ammouiae carb. aj, potassii broin. ass, aqum avj. HI. S. 
Tablespoonful every hour. R—Salt and water enema at once. 
Water and tinct, arnica to wound. 
Evening. In statu quo. Carphologia. R—£ grain sulph. 332 
Original Communications. 
[Nov. 
morphine every three hours, to procure sleep. 20 grains carb. 
ammonia every three hours. Salt and water enema at once. 
April 5th. Died at 4 a.m., quietly. 
Duration of erysipelas 5 days. 
Necroscopy.—6 hours after death. Body anaemic; muscles 
well developed, exsanguineous. Cranial Cavity.—Except a slight 
congestion of the blood-vessels, and especially those of the pia 
mater, the contents of the skull were normal. Thorax.—Lungs, 
two or three small pleuritic adhesions; otherwise perfectly 
healthy. Heart, normal; contained fibrinous (yellow) heart clots 
in all its cavities. Two typical “plaques laiteuses,v about size of 
a 25 cent piece, on its outer surface, traces of former pericarditis. 
Pericardium, healthy. Abdomen.—Liver, seemed normal. Gall 
Bladder, contracted down; contained but a small quantity of 
dark green bile. Spleen, slightly hypertrophied. Stomach and 
Botcels, were not examined, as they looked healthy, the latter 
filled with gases. Pancreas, normal. Kidneys, seemed hyper- 
trophied ; 3 or 4 sub-serous ecchymoess ; otherwise healthy. 
Resume.—Incised wound of the foot. Sudden elevation of tem- 
perature. Erysipelas. Looseness of bowels. Araxia. Delirium. 
Hiccough. Death. Treatment for erysipelas: 2 grains sulph. 
quinine every hour; collodion and water and tinct. arnica l.d.; 
carb. ammonia ; brom. potassium and sulph. morphine. Enemas 
p. r. n. Eor injury : Purgatives p. r. n.; compression, ligature 
and acupressure of vessels; eo-aptatiou of lips of wound. Post- 
mortem : negative. 
Remarlcs.—The sudden rise of the temperature in this case, 
reaching 105°4/ in 24 hours, was by itself sufficient to make the 
diagnosis, inasmuch that erysipelas was in the ward. At the 
same time the wound assumed an unhealthy appearance, with a 
very high local heat. Twenty-four hours after the first appear- 
ance of the eruption it faded, while a looseness of the bowels 
augured bad. This last symptom having been checked, was 
followed by adynamic symptoms, hiccough, and a suppression 
of the exanthema, which rendered the case a desperate one. 
These symptoms soon increased, and death, preceded by com- 
plete delirium and earphologia, followed before the completion 
of the sixth day. 
This sudden disappearance of erysipelas, with such alarming 
brain symptoms, is what is sometimes called a metastasis or 
translation of the disease to the brain. Besides, that these 1874] 
LeMonnier—Erysipelas: Sulphate of Quinine. 
333 
words do not give us a clue to the manner in which this sudden 
change takes place, we have seen that the results of the post 
mortem have been most unsatisfactory. It is certainly not a 
very slight congestion of the vessels of the brain, and especially 
those of the pia-mater, nor the heart clots, that have caused death. 
To be candid, let us admit that, once more, death has occurred from 
erysipelas, with our inability to account for it, and without any 
satisfactory result from the necroscopy. 
The treatment has been the same in this case as in the preced- 
ing ones, which were all cured. Quinine formed the base of it, 
being given in small and repeated doses. This drug has been 
given in this disease for years back, with different explanations- 
It certainly seems to be of all drugs the one that has been the 
most patronized. 
Deductions from the Preceding! Observations. 
If quinine has not the power of checking the march of erysipe- 
las, or of abridging its duration, it certainly seems to be capable 
of mitigating its symptoms. I am not prepared to say positively 
that it does abridge, and in some cases cut short the disease, 
but observations do lead to this conclusion. Dr. Perroud* 
asserts that it does. He reports five cases in which the exanthema 
lasted from four to eight days after the administration of the 
drug. But at the time he made his experiments the disease did 
not reign epidemically in his wards, as it did in mine. For five 
months I have had the distemper reigning epidemically in my 
wrards, so much so, that on many occasions, when practicable, 
I dared not use the knife. For three months previously pymmia 
was of frequent occurrence. 
I am satisfied that quinine is powerful for good iu this disease, 
and will continue to believe it until proved otherwise. I am 
always ready to change or alter my opinions according to facts, 
the result of strict and impartial observation at the bedside. I 
hope that those of my confreres who may feel interested in this 
subject will pursue its study further, and permit us to hear from 
them. 
When we think how serious and deadly this affection is wrhen 
it becomes epidemic, and how powerless then is our therapeutics, 
we should try by all means to find a powerful treatment against 
* Loe., cit. 334 
Original Communications. 
[Nov. 
its ravages. See how lethiferous was the epidemic which raged 
in Louisville and its hospitals in 1844-5-6. 
All my cases but one have shown mild symptoms, in spite of 
the bad state of health of some of the patients, and the diatheses 
under which they labored—alcoholism, tuberculosis, scrofula, 
syphilis, etc. 
As stated previously, erysipelas prevailed throughout the win- 
ter, in one or more wards of the hospital. Some of my colleagues 
have had to contend with deep seated abscesses and other alarm- 
ing symptoms. But for Case 12, which terminated fatally, I 
Avould have been able to advance the probability that, with the 
quinine treatment erysipelas will not terminate fatally. But that 
treatment is the best which gives the best results. The future 
will decide. For the present, we have good grounds to try this 
modus curandi. 
If we consult the works of the different authors, old and recent, 
on the treatment of this disease, we see almost every one, if not 
all, for one reason or another, recommend.# he use of quinine, 
without (except Dr. Perroud) stating what its modus operandi is. 
It will be seen that I gave to my patients 2 grains, sometimes 
less, of quinine every hour or two, fed them ad libitum on the 
best diet, and yet cured them with little or no serious symptoms. 
What a difference with the views of the old school, and of those 
who practised some 30 years ago, when the mildest treatment 
was a blood-letting of some sixteen ounces or more, a powerful 
purge, and a strict diet! “And yet,” says an author, “ the patients 
would die in spite of our doings, although we might have hied 2, 3, 
and 4 times P Were our predecessors to rise from their graves, 
they, like Kip Van Winkle, would be astonished at the change 
that has taken place, and wonder at the sight of their lancets 
rusted from disuse. 
Action of Peruvian Baric on the Nervous System—Mr. Briquet, 
one of the many who have made a special study of the action of 
Peruvian bark, asserts and proves, from the many experiments he 
has made on animals, and the numerous observations gathered 
from both healthy and sick persons, that “the alkaloids of bark 
have a direct and almost instantaneous action on the cerebro- 
spinal axis.” 
He divides his experiments into two periods, Recording to the 
doses given, and thus enables us to account for the apparently 
contradictory results obtained daily by practitioners. 1874] 
LeMonnier—Erysipelas: Sulphate of Quinine. 
335 
In the first period, if the salt be given in small doses, the cere- 
bral functions are excited; in the second, if these doses be kept 
up and increased, they have a sedative effect. From his experi- 
ments on animals, he proves that the period of excitement is in 
direct ratio to the rapidity with which the quiniue salt has 
reached the brain. The excitement is almost always of short 
duration. 
The second or sedative period, on the contrary, acts in direct 
ratio to the slowness with which the drug reaches the brain, as, 
for instance, when it is given by the stomach progressively" and 
gradually. In this case, the sedative period is as long as the 
absorption is slow. 
Observation has proven, that the effects are the same on man 
as those obtained by experimenting on animals. Quinine given 
to man, in small doses, produces an excitement of short duration; 
but when a large quantity is given, in small and repeated doses, 
it has a sedative effect of loug duration. 
Eulenburg has made some very interesting experiments with 
sulphate quinine. His object was to find out what portion of the 
cerebro-spinal axis was first acted upon by the drug (Archiv. 
fur Anatomie, etc., 1865, iv., p. 423). He considers himself 
authorized to conclude that, sulphate of quinine first acts on the 
spinal marrow, where it paralyzes the centres of reflex action. 
Secondly on the brain, w here the centres of sensibility and volun- 
tary movements are paralyzed. He comes to this conclusion 
from the following fact: A frog, poisoned by sulphate of quinine, 
is, in the course of 10 or 20 minutes, insensible to physical and 
mechanical excitements. It still, however, possesses sensibility and 
motility, for if the animal be placed on its back, it will attempt to 
turn over on its belly. Quinine seems to have no action on the 
nerves, but if applied to a ireshly cut muscular surface, it causes 
a contraction, wrhereas if the muscle be plunged in a solution of 
sulphate of quinine, it soon loses its contractility. 
Action of Peruvian Bar~k on the Circulatory System.—Here again 
the action of bark is twofold and in apparent contradiction. 
Quiniue in small doses and long intervals (3 to 6 grains in several 
doses) gives energy to the beatings of the heart, increases its 
force and the frequency of the pulse. 
But given in large doses and progressively (i. e., from 20 to 60 
grains in the 24 hours), quinine has a marked sedative effect on Original Communications. 
[Nov. 
336 
the cardiovascular system, as shown by a marked slowness and 
weakness in the beatings of the heart and pulse. 
Besides this hypostheuic action on the circular system, quinine 
in large doses also possesses a depressive influence on calorifica- 
tion. While it diminishes the force and frequency of the pulse, 
it lowers to a marked degree the temperature of the skin. Ac- 
cording to Dr. Briquet, this refrigeration is the direct result of 
the abatement of the circulation, and is always in proportion 
to it. 
Such are the effects which I have obtained from the adminis- 
tration of quinine. I gave it as soon as the first febrile symp- 
toms showed themselves, and kept up its use during the febrile 
stage. By its continued administration, the pulse and tempera- 
ture were often seen to fall considerably, and rise again if the 
drug was too soon discontinued. 
Quinine as a Prophylactic of Erysipelas.—The good results 
which I obtained from this drug in the treatment of erysipelas, 
the explanations set forth, as its modus operandi, led me to try 
it as a prophylactic. From the following facts I think we can 
consider it, until otherwise proved, as a preventative of that ery- 
sipelas which so often complicates wounds. 
“When the disease is epidemic,” says Dr. Gross, “it often 
shows itself withiu a very short time after the receipt of an 
injury, however slight or insignificant. Under such circum- 
stances, indeed, I have, as already stated, known it to follow 
upon the most trivial wound, ” 
I mentioned above, that the distemper raged in my wards for 
five months, during which time I dared not operate. 
Case 3 shows that the patient was operated upon on the 10th, 
and on the morning of the 21st he had erysipelas at seat of injury. 
On that day, the 21st, I had to operate upon a patient for a 
fistule of the left nates. 1 had then three cases of the exanthema 
in the adjoining beds. It was then that I first prescribed quinine 
as a prophylactic, and with the following result: 
Joseph Sanders, aet. 47 years, Canadian, laborer, entered my 
ward April 20th, 1874. Discharged, cured, May 8th, 1874. Diag- 
nosis—Fistule of left nates. Treatment—Incision of fistule on 
April 21st; quinine as a prophylactic (2 grains every 2 hours, 
then 3 times daily), there being erysipelas in the ward. 
Duration 17 days. 
He was therefore 17 days in an infected locality; his wound 1874] 
LeMonnier—Erysipelas: Sulphate of Quinine. 
337 
progressed satisfactorily, and he was discharged cured without 
having had the distemper. 
From this day 1 gave quinine, in 2 grains doses 3 times daily, 
to all the patients upon whom I operated, and have not had any 
new cases of erysipelas among them. One patient (vide Case 
7),.to whom I did not give it, not thinking it necessary, was 
taken sick with the disease on May 1st, 1874. 
It is to be hoped that future observations will prove quinine to 
be a prophylactic against erysipelas. 
Before dropping m}r pen, I wish here to return my thanks 
to my friend, Mr. J. L. Deslattes, .Resident Student Charity 
Hospital, for the valuable services he has rendered me, and 
for the promptness and accuracy he has always shown in 
observing my patients during my absence and in gathering 
information. 
28 Conti Street, New Orleans, July, 1874.