may be said with great confidence that intermittent fever is one of the few diseases which the physician expects 'to combat successfully by the administration of drugs. There are drugs which have a specific curative action, and also those which have a decidedly beneficial effect as adjuvants. The prineipatspecific remedy is Peru vi•n bark, or its alkaloids, which areeeommonly preferred. Of these, quinine and ein chonidia, usually in'the form of sulphates, are most used. Quinia lies been long in use as an antiperiodic, but cinchonidia is a recent introduction. It is much less expensive than quiuia, and by many its action is preferred, as beiug milder and more permanent. The dose of quinia varies with the constitution and condition of the patient, but as a general statement, in a case of well developed tertian, the cure will require from 20 to 60 grains, of quinia sulphate, or one-half more of cinchonidia, divided into 5 or 10 repeated doses; and it is advisable to give iu counection some alkaline salt, as the bicar bonate of soda, or of potash; or when a laxative effect is desired, Rochelle salts. It is often advisable to precede the administration of the anti-periodic w ith a cathartic, and for this purpose there is nothing better, if the patient will consent to take it, than pow dered rhubarb, in the dose of a dram or more.. Less may be given if combined with one-half or one grain of podophyllin; or podophyllin may be given alone, or combined with five or six grains of calomel. The quinia or cinchonidia is often given to the extent of producing ringing in the ears, one of the symptoms of gaininism. This, however, is not always advisable or necessary; a continued use of one of these remedies during con valescence, in conjunction with some preparation of iron, generally Meets the demands of the case.
Dr. Gaspar Griswold of New York has used the alkaloid of jaborandi, in the form of muriate of pilocarpin, in a number of cases of intermittent fever, and his reports in the Medical Record indicate that the remedy possesses great value. It does not appear that the remedy has any specific action on the snateries morbi of the disease, as many suppose to be the case with qninia, but that it breaks up the stages of the attack in consequence of its powerful diaphoretic qualities Dr. Griswold administers it using from one-sixth to one-fifth of a grain, dissolved in water at the commencement of the cold stage. The effect is to bring on the second or sweating stage in a few minutes, thus abolishing the hot stage.
The results in one of the cases which occurred in 1879 are given in the following table: The patient bad no more chills during the next ten days without further treatment, and was dischar,ged as cured. These results, if verified, may change somewhat preva lent views in regard to the therapeutic action of quinia. Here we have a remedy which seems to net by interrupting the stages of the paroxysm; but jaborandi may possibly have some specific action also.
Malignant intermittent or Pernicious intermittent fever, sometimes called congestive intermittent.—Intermittent fever, ordinarily not it dangerous disease, has a form the cause of which is not always discoverable, but which is one of the most fatal diseases. Fortunately the cases are rare, except during certain seasons, in very malarious regions. It is more prevalent in the southern and western states, as the level portions of Alabama, Mississippi, Louisiana., and about the estuaries of some of the creeks and rivers emptying into the great lakes. Sometimes the malignant character of the attack is not manifested in the first paroxysm, or even the secon.t, and is thus likely to deceive tile practitioner; but it often reveals itself in the first paroxysm, and may then cause death. Prof. Drake
states that the first symptoms, however, are more or less anomalous, and will give warn ing, especially if other Cases have taken place in the neighborhood. The symptoms vary, and yet to the experienced are characteristic, taken in connection with the history. The patient bacomes rapidly delirious, or stupid, or comatose; or coma may follow delirium. Sometimes epileptiform convulsions occur. In some cases there is very great sweating, and sometimes the extremities become as cold as marble. Sometimes there is vomiting and purging, followed by a collapse, as in cholera. Sometimes the urine fails to be secre ted, and frequently there is albuminuria. There is often hemorrhage from the stomach, bowels, or kidneys, or all of these organs. The pulse is small and irregular, and there is often great in breathing. If the pulse gets fuller the patient may get relief, but if the paroxysm passes off without much improvement, the next.one will not unlikely prove fatal. The pathological conditions found after death do not differ essentially from those found after death from ordinary intermittent fever, except that they are intensi fied; and it is possible tkat the disease is caused by the generation within the system of an excessive amount of malarial poison, the eliminative functions of the system not hav ing acted. During the prevalence, of intermittent if there be a tendency to the malignant type, the number of these cases will be diminished by adopting, generally, prompt, active, and sustaining treatment. During the paroxysm the application of warmth in various' ways, by warm blankets, bottles of hot water, hot bricks, or other materials, as sinapisms, should be made. The administration of chloroform, in dram doses, is recommended on good authority, the dose 14eing repeated, if necessary, till anes thesia is produced. But the chief reliance for the expulsion of the disease is in the administration of quinia or cinchonidia, and the action of either of these medicines will be much promoted by giving it in connection with those simple alkalies which have been found to give activity to the secreting functions of the skin and glandular organs, such as the carbonates of soda and potash. Ammoniacal carbonate may also be found use ful. Wine is demanded, probably in every case, and all possible means of supporting the strength should be employed. The diet should be carefully selected with regard to the condition of the patient. Beef-tea, the staff diet of the sick-room, is not to be omitted, and steak may be chewed and the juices swallowed if the patient have any appe tite for it. All articles of food should be liberally salted. The axiom that recovery from disease consists in regeneration of tissue should not be lost sight of in the treatment of this disease more than in any other. The nervous system should be supplied with the best products of nutrition. During a state of coma, or at other times, if the stomach be irritable, quinia may be administered by means of a hypodermic syringe. The drug is dissolved in water containing 10 drops of sulphuric acid to the ounce, and from 20 to 40 grains are sometimes administered. The chief objection to this mode is in the bulk of the injection, and the inflammatory swellings that are liable to ensue. But these must be regarded in connection with the dangerous condition of the patient. Tepid bathing must not be neglected. If recovery takes place, but the malarions cachexia remain, a change of air and climate will be advisable, and the place selected should have an atmos phere ns pure as possible. Colorado possesses the climatic conditions desirable in such cases.