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Gen. II. Anetus. Intermittent fever. Medical treatment. Its progress checked by an im. proper administra
ful engine; that in many instances it was highly serviceable; and that in those in which it failed, the miscarriage was rather to be ascribed to some error in handling it, than to a want of power in the drug itself.
Sydenham had sufficient ground for this last conclusion. The mode in which it was, at this time, usually administered, was in doses of two drachms given twice in the twenty-four hours; and, as already observed, the time selected for the purpose was during the existence of the paroxysm. It is moreover highly probable that it was sometimes considerably adulterated, from the difficulty of obtaining it in any considerable quantity.
In 1658, we learn from Sturmius, who warmly patronized its use, that pure bark was so scarce on the continent, that twenty doses of the powder were sold at Brussels for sixty florins, for the purpose of being sent to Paris; and that this order so completely exhausted the apothecary's stock, that he himself was incapable of obtaining any even at that price. And hence for the use of one patient, who was attacked with an obstinate intermittent fever in the month of February of the same year, he was obliged to wait till the June following before he could obtain a supply*. Nor was it less difficult to be procured at Brussels, than in many other parts of Europe; for Bartholine, then residing at Copenhagen, having received as a great rarity a present of three doses, or six drachms, of the powder, from some friends who had brought it from Italy, was induced to make a trial of it on a lady who had a quartan fever. Of this small portion the first dose, or two drachms, was rejected from the patient's stomach; and, in order to prevent a repetition of this accident, and consequently the loss of his entire stock, the administrater macerated his two remaining doses in wine for forty hours, and gave the infusion during two successive paroxysms. The only effect was, that the fever was changed from a double to a single quartan. And here the experimenter was obliged to
• Febrifugi Peruviani Vindiciarum Pars prior, p. 84. Antwerp. 1659.
stop, as having no more materials to proceed with*. But Gen. II. even in 1678, when the same pretext for sophisticating it int no longer existed, Morton complains that the bark of- tent fever. ; ferred for sale was become so inert, corrupt, and adultera- Medical ted that it was necessary to increase the proportion from treatment. two drachms, to one, two, or even three ounces for a single dose. And, thus given by wholesale, we cannot wonder that still more mischief should result from its abundance than from its scarcity, whatever might be the purity or impurity of its quality.
To guard against all the evils that seemed to accom- Sydenham's pany its use, Sydenham proposed to himself the follow- regulations. ing regulations:
Firstly, To be peculiarly cautious in the quality of the bark he employed; and to allow of no intermixture whether from fraud or a view of increasing its virtue.
Secondly, To administer the bark in the intervals instead of in the paroxysms of a fever.
Thirdly, To give it after the rate of two scruples every four hours, instead of two drachms twice a-day after the Schedula Romana.
Under these regulations the bark seems to have acquired all the success to which it has at any time pretended; and modern practice has added little to their value. The most important of them is that which effected a Adminis
tration in change in the period of exhibiting the bark. But the apy whether the merit of first suggesting this improvement rexy, by
" whom first be due to Sydenham, or to some contemporary of his, suggested. we cannot at present very accurately determine. He is, indeed, the only person who openly lays a claim to it, and asserts that he was led to this alteration after deeply pondering the subject-diù multumque apud se agebat: yet Morton who published his Pyretologia in 1692, only Morton's three years after the death of Sydenham, asserts, some-P what loosely indeed, that during twenty or five and twenty yearst he had been in the habit of giving this an
• Thomæ Bartholini Hist. Anat. et Med. Cerit. v. Hist. L. Hafniæ, 1661. + Pa. 114, 132.
Gen. II. tidote, as he calls it, in every season of the year, and to Intermit
persons of all ages and constitutions; that he had cured tent fever. every species of intermittent with it quickly and radically; Ague Medical
and had found it more expedient to give it in the intervals than in the fits. While Lister, who was contemporary with both Sydenham and Morton, and who treats neither of them with respect, directly accuses Sydenham, a few years after his death, of having copied his mode of giving the bark from the miserable mountebank Talbor,
who was its inventor;--auctore suo, misero illo agyrtâ Tabor's suc- Talbor*. Talbor or Tabor, however, is scarcely open cess,
to the stigma of being a mountebank. He concealed, indeed, his preparation of the bark, but he had been regularly initiated into a knowledge of medicine by an apprenticeship to an apothecary at Cambridge: was the
most successful, and therefore the most popular employer and reputa of the bark in his day; acquired a higher reputation in tion.
this line of practice than any other individual whatever ; was appointed one of the physicians to Charles II. against all the influence of the College; was specially sent for to Paris to take the dauphin under his care; succeeded in curing him; and afterwards divulged his arcanum for a stipulated sum to Lewis XIV.: by which it was found to be an infusion of the powder of bark in port wine as a cordial..
The best form of administering it has hitherto been forms and
held its powder, “ potissima virtus in toto jacet” says prepara
Professor Frank. But it is often found that the stomach will not bear it in this form; and hence, modern chemistry
has been at work to provide various others: the best of Its essential which appear to be those which consist of its essential principle, a principle, now sufficiently ascertained to be a peculiar bitter alkali.
bitter alkali, separated from the woody fibre, and neutralized into a salt by means of sulphuric acid. The French
chemists have put us into possession of two distinct salts Quinine and of this kind-QUININE and CINCHONINE, of which the cinchonine.
* M. Lister Octo Exercitationes Medicinales de Cort. Peruv, exhibendi tempore.
former is the more powerful, and both appear to have Gen. II.
i Anetus. been employed with great success in the removal of intermittent fevers, in cases where the stomach has uniform- tent fever. ly rejected both the gross powder and the decoction*. ; The dose of the first for an adult may vary, from five treatment grains to half a scruple, and still more has been given . without ill effects; of the second, the dose may be from ten grains to half a drachmt. The ordinary ill effects from Effects of an over-dose are nausea, head-ache and vomitingf. Dr.
over dose, Elliotson has also employed the quinine alone in its alkaline and impurer state, as being far less expensive than the sulphate, and apparently with equal success g; but in this case, the remedial power being less concentrated, the dose must be nearly doubled. Peruvian bark has moreover given forth to the indefatigable labours of the French chemists, a peculiar acid, as well as the above alkalies, which they have characterized by the name of Quinic or Quinic, or Kinic: but the remedial powers of which have not Kinic a hitherto been sufficiently ascertained for general practice. But as under whatever form, in whatever quantity, and Cinchona
not always at whatever time the bark is given, it is not found to be effec a specific, not only in every individual, but in every in- and why. termittent; we are again driven to a principle I have already ventured to lay down, that intermittents of all kinds are occasionally influenced in their character by idiosyncrasies or the temperament of the atmosphere. And it is hence, of considerable importance to know what other medicines have the strongest claim to attention, when, from accidental circumstances, the best fails of its common effect.
This, as we have already had occasion to observe, was Hence the case in the singular intermittents that prevailed both other febri
"fuges in this metropolis and in the country in the year 1787, in should be which the bark seemed to have no energy whatever, nota
• De Cur. Hom. Morb. Epit. Tome 1. p. 64.
# Magendie, Formulaire pour la Préparation et l'Emploi de plusieurs Médicamene, p. 49, Paris 1822.
S Medico-Chir. Trans, Vol. XII. p. 553.
Gen. II. withstanding that its genuineness was sufficiently tested
and proved. In consequence of which the febrifuge powers Intermit. tent fever. of various other medicines were attentively studied and Ague.
appreciated. In some instances other medicines were treatment. mixed with the bark, and seemed to a certain extent to Mixture of call forth its proper power; a mixture of bark and alum with other
answered in some cases, but produced disappointment in medicines. others. “ The crude sal ammoniac", says Dr. Petrie, Petrie's
who was physician to the hospital at Lincoln, “ had not practice at Lincoln. a more certain effect. Several women were cured in an
hospital by what is called the Dutch remedy for an ague; which is compounded of the bark and cream of tartar, each two ounces, and sixty cloves powdered. A drachm and a half of this powder was taken every third hour. Yet this likewise frequently failed. We at last thought that we had fallen on a specific in the powder of bayleaves, plucked from the tree and dried in the shade. It was given from one to two scruples in the beginning of the cold fit. This powder was very efficacious in preventing the fits in many cases, where the bark, in the largest quantity, had been unsuccessful. But almost all who used it had a relapse in the space of a fortnight, three weeks, or a month. One patient, just at the time the fit was expected, took sixty drops of the Thebaic tincture. On this he fell into a profound sleep, sweated profusely, and escaped the fever, not only then but at two successive periods. Eight quartans in the hospital, and four in private practice, were entirely cured by one drachm of the theriaca andromachi, the same of the root of calamus aromaticus in powder, and fifteen grains of salt of tartar. This mixture was taken in warm ale or wine and water, an hour or two before the fit. Nevertheless I must confess that I met with several cases where no medicine prevailed ; and many patients despairing of relief left themselves to nature ; some of whom went into a pulmonary consumption, jaundice, or dropsy. Many, whom I thought cured of quartans, lately relapsed. I have now on the hospital books four patients, ill of quartan fevers, who have received no benefit; and I have no