TREATMENT OF INTERMITTENT

FEVER.

Before the discovery of the tubercle bacillus, many a cough was allowed to continue without treatment and the

real difficulty not suspected until a sharp hemorrhage or a hectic fever revealed the true situation. Only a few months ago diphtheria patients walked the streets with a simple sore throat, while cases of follicular tonsillitis were carefully treated as diphtheric in character. Nearly all

of us were taught that malaria was an earth-born poison which filled the air with "a fever-generating agent." Now, all this is changed. The tubercle bacilli can be detected in the earliest stages of phthisis. The KlebsLoefler bacillus decides the presence of diphtheria; and the malarial germs of Laveran tell us we have an intermittent fever.

It is natural that we look for a remedy which will destroy these germs or counteract their poisonous products. Indeed, it now appears that we have, unconsciously to be sure, been giving a perfect specific for the cause of the latter disease. Quinine is no longer administered in an empirical manner. We know precisely why we give it and what it does. Quinine exerts a deathly influence over the malarial germ, therefore it may be given with the satisfaction of knowing that it will invariably check the paroxyms of an intermittent fever. If its use is not followed by this cure, then it is certain that it never came in contact with the red corpuscles of the blood. Absorbtion was incomplete or the quantity of the drug was insufficient. In the light of all this it is certainly bordering on the ludricous that the National Dispensatory should give a list of seventy-six remedies in the index under Intermittent Fever.

The patient has usually had a malarial paroxysm before seeking medical advice. As hepatic activity is necessary to obtain the best effect of the specific treatment, so, in cases of constipation at least, it is better to begin the treatment with the following prescription which should be taken five or six hours prior to the quinine:

R. Hydrarg. Chloridi Mite Sodae Bi-Carb., aa gr. 1. M. Divide into six powders. Sig.-Take one powder every fifteen minutes, using all the powders.

This is far preferable to giving the calomel in one single dose and in large quantity. However, it may be necessary, if the patient is insensitive to purgatives to increase the quantity in the prescription by one-half. While this preparatory treatment is not necessary, yet it is certainly true that after its employment a less quantity of quinine is required and the general condition of the patient is improved.

To insure prompt and complete absorption the quinine is best given in liquid form. The following is a favorite prescription:

R. Quinia Sulph., grs. xv.

Aquae,

oz. j.

Acid Sulph. Dil., . s. ft. sol. M. et. Sig.-Take at one dose in one-third glass of water.

With the above preparatory treatment and with the quinine dissolved, this dose is equivalent to at least twenty grains given after the usual manner; while it is certain we should not trust to pills or capsules at such a time unless we know positively that these are in a perfectly soluble condition.

To prevent the uncomfortable head symptoms which accompany full doses of quinine and also to relieve the pain which is likely to be present at the same time of the expected paroxysm, the following prescription should be given four or five hours after the specific:

R. Antikamnia Tablets (5 gr. each), No. xxiv. Sig. One tablet every two hours while pain necessitates.

While the above dose of quinine is sufficiently large for residents of most parts of the United States, yet in some of the Southern States and in other sections where malaria abounds with unusual force, it may be necessary to give the quinine as high as twenty, forty or even sixty grains. But in the great majority of cases the above single dose will be sufficient to prevent a second chill.

In order that there may be no question about the recurrence of an attack, and also in order to bring the system under the influence of a good tonic, the quinine should be continued for

one or two weeks in doses of 5 to 10 grains a day. As the malarial germ has left its effects on the nervous system and often to a marked degree, so a remedy is indicated which will put at rest the disturbed condition. The following will be found satisfactory in every way:

R. Antikamnia and Quinine Tablets (5 gr. each), No. xxiv.

Sig.-One tablet three times a day, after meals.

This tablet contains 2 1-2 grs. Sulp. Quinine and 2 1-2 grs. Antikamnia, being the most desirable proportion.

If the physician be called while the patient is suffering from a paroxysm, and he is in doubt as to its nature, he has only to remember that any intermittent fever which resists the action of quinine is not necessarily of malarial origin. Even during the chill of a malarial attack the temperature may rise to 102 degrees or higher, while it is often true that when a chill has passed and the fever is on, the thermometer will show a lower degree of heat. Therefore, no better treatment can be given at the beginning of or during the chill, than the following: R. Antikamnia Tablets (5 gr. each), No. xxiv.

Sig.-Take two tablets immediately.

Repeat dose in two hours if pain necessitates.

The antikamnia will relieve the congestion of the abdominal and thoracic organs and will materially alleviate the headache of the second stage especially. In fact, it practically robs the fever of its most distressing features.

When we consider that the cause of intermittent fever is so thoroughly understood and that quinine is regarded as its specific, destroying said cause, how purile are all attempts to bring forward new substitutes. Although pain may not be dependent upon any special living organism, yet it is certain that in antikamnia we have a most reliable specific.

In regard to the treatment of all forms of febrile maladies, periodic or continued, I have found Antikamnia tablets with its various combinations of codeine, salol or quinine, (as indicated in each individual case,) the most reliable, prompt and satisfactory remedies in controlling these intractable disorders of any remedial agent known to me in an general active practice of over thirty years.

WALTER M. FLEMING, M. D.,

240 Fifth Avenue, New York City.

558

THE SAFEST OF HYPNOTICS. A thorough review of the literature oon Troinal, in connection with a large personal experience in the use of this drug, lead Guttmann to the conclusion (Reichs Mediz. Anzeiger, No. 8-10, 1895) that in comparison with other hypnotics it possesses the most advantages and the least disadvantages. In a case occurring in his practice in which owing to persistent insomnia, it was found necessary to administer Trinal in large doses, sometimes several times daily, and for a period of six weeks, no toxic symptoms of any kind were experienced, and when discontinued the patient manifested no ill results. It acted promptly when other drugs. such as bromides, chloral and morphine proved inefficient. Later when its use was resumed the same favorable effects were obtained, and was found to produce refreshing sleep even in the presence of pains. According to the reports thus far published Trional is utterly devoid of any injurious influence upon the heart, and its freedom from after-effects render it especially adapted for children. The field of action of this remedy extends to all forms of insomnia, both in those who are mentally sound or demented, unless violent attacks of psychical, motor or sensory restlessness be present. In cases of the latter kind, it is necessary first to allay the marked excitement by other remedies, and for the relief of pain Guttmann prefers to opiates the combination of Phenacetine with Trional. As one of its most agreeable properties he regards its antihydrotic effects which renders it especially valuable in phthisical cases. During its prolonged administration attention should be paid to regulation of the bowels, and carbonated waters or bicarbonate of soda should be given. The doses of Trional varies from 1.0 to 2.0 gm. for adults, 1.5 gm. being a medium dose; for children 0.2 to 1.5 gm. are required. It is best administered in warm fluids or in carbonated fluids, such as milk and seltzer. Ten to fifteen minutes after its administration a deep, physiological sleep ensues, from which the patient awakes refresned. In fractional doses during the day it sometimes allays excitement and relieves pain.

Mathison recommends trional as a hypnotic in cases of morphine habit.