this) he is too quick to jump at conclusions, and I am satisfied that his investigations into the cause of hemoglobinuria were not extensive and protracted enough and his findings. incorrect. In a practice of nearly eighteen years in the Mississippi Valley I have yet to see this result from quinia. For a long time nearly every physician administered this remedy for that affection, with many recoveries. Italian, Indian and South American authorities defend quinia and protest against Koch's unjustifiable declaration. The experiences of men who have devoted their lives to the practice of medicine in the malaria-stricken districts of Italy, India and Brazil, should surely have more weight than the hasty and superficial conclusions of visitors. Dr. W. H. Crosse, the chief physician of the Royal Niger Co. of Central Africa, and Prof. Rem-Picci of Rome, say that they have "never seen a case in which hemoglobinuria developed as the result of the use of this drug.”

I can but express my opinion, that when quinia fails, perhaps from insufficient exhibition, look out for hematuria; and this largely on account of the toxic influence of foreign material in the blood—namely, the remains of the plasmodia and their destructive action. It is true that, after hemoglobinuria has developed, quiuia in large doses is not indicated, because it has no mission to perform, supportive and eliminative treatment being called for.

Neuralgia, dysentery and nephritis, quite often of malarial origin, yield better to systematic administration of quinia than any one remedy. Estivo-autumnal fever will yield to quinia if given in pronounced dosage; opium, in the shape of Dover's powders, often acting as a useful adjunct.

In conclusion I would say that, if we study the medical history of our own Mississippi Valley, we will find that innumerably more lives have been lost, and untold suffering and anxiety caused, by an insufficient, rather than excessive, employment of quinia.

Discussion.

Dr. Sale: I approve everything the gentleman has said, but he should have spoken on the abuse of quinine. The old maxim, "When in doubt use quinine," most fallacious. Quinine will produce a gastritis analogous to alcoholic gastritis. I never use it hypodermatically, for I have seen it thus used only a few times where trouble did not follow. Some malarial fevers are unaffected by it. Nor have I ever seen a cold broken up by it.

Dr. Reilly: I think the paper scholarly, though I do not agree with the author as to the therapeutic value of quinine. In the treatment of the so-called "slow fever,” I agree with Dr. Sale that here quinine has no effect. Especially in the estivo-autumnal infection, it has not the therapeutic value claimed for it. Dr. Nelson: I think the paper a timely one. My experience is that quinine is not an irritant. The old women use a solution of it for sore eyes.

Dr. McSwain: It has been my custom for years to give small doses of Dover's powders or morphine with quinine, with excellent results. Two effects of quinine are nausea and headache, which have led me to use a solution of sulphuric acid, which has done away with unpleasant nervous complications.

Dr. Sanford: The essayist's claims as to quinine in estivo - autumnal fevers are not justified by modern experience. I would like to ask if he had a microscopic examination, and what size doses he gives in this class of cases.

Dr. Alexander: I did not rely on microscopic examination in estivo-autumnal fevers, but on clinical symptoms. I give five grains of quinine every four hours for forty-eight hours, and two and a half grains of pulverized Dover's powders every eight hours, in estivo-autumnal fevers, and keep fever down. I did not intend to speak of the careless use of quinine. As to abscess being formed, I had rather have one on my patient's arm than to have a dead patient.

JUVENILE GONORRHEA.*

BY CHAS. R. SHINAULT, M.D.

HELENA, ARK.

One of the objects in the presentation of the following report. of cases is to bring to view and keep ever in mind the fact that gonorrhea in children, although rare, is one of the diseases of which we must not lose sight.

The first case to which I shall direct your attention is that of a young negro boy, aged 8 years and 2 months, who came to me during the month of March, 1896, accompanied by his father, who stated that this was the boy's third attack; the first two having occurred at the age of 63 and 7 years, respectively. There was nothing abnormal in the development of the boy's sexual organs. However, if my nature were a little more artistic, I might possibly have discerned that in point of development they could hardly have been referred to as things of small matter. The boy's general appearance was that of a precocious youngster, and the previous history of the case would seem to bear out the suggestion of that idea. Read before the Tri-State Medical Association, Memphis, December 22, 1898.

The treatment instituted for the relief of this patient was that of the "Valentine" method, somewhat modified, and was as follows: Two irrigations daily, consisting of a quart of hot water containing two and one-half (23) grains of permanganate of potash. The morning injection consisted of irrigating the anterior portion of the urethra, while the evening irrigation was cystic. No complications occurred, and the case was dismissed on the twenty-first day.

The next case is that of a young white boy, 10 years of age, who came to me on the 3rd day of June, 1898. The treatment instituted was two and one-half (2) grains of permanganate of potash, twice daily, as above, for seven days, and three times daily for another seven days, and ten grains twice daily for ten days longer, which ended course of disease.

The third case is that of a boy 13 years of age, who also came to me on the 3rd day of June, 1898, and received like. treatment until the twentieth day, at which time an orchitis developed, which lasted ten days. At the expiration of this time all discharge had disappeared.

The next and last case was that of a boy 15 years of age, markedly undersized, who came to me August 28, 1898. In this case three grains of permanganate of potash to a quart of water were used twice daily for one week. At the beginning of second week an epididymitis appeared, with cessation of discharge for the time being. The epididymitis lasted ten days under treatment generally instituted in such cases. At the expiration of this time the treatment was again resumed, which ended the course of disease in about two weeks.

Other cases of similar character have come under my observation during the course of my professional career, but unfortunately I have preserved no record of them.

In speaking of gonorrhea in children, I have intentionally neglected to refer to cases of gonorrheal ophthalmia, which might be referred to as a disease not infrequent in infancy. I have furthermore failed to say anything concerning gonorrhea in children innocently acquired, and have presented the above cases for the purpose of bringing to light the early age at which sexual desire and cohabitation are indulged in in certain portions of our country.

VOL. XIX-2

That we are a worse lot, morally, in Arkansas than in Tennessee or Mississippi, is a question the answer of which I do not happen to know. However, that the above reported cases were of venereal origin, is the opinion of the writer.

There is in me at this time no desire to open a discussion of the treatment of gonorrhea in general, but I would suggest that the old methods are things practically of no value; and for my part, if thorough irrigation caunot be indulged in—namely, where there are no strictures or other complications-then just take off the bridle and let it run. This in the end, I believe, would be a better course to pursue.

One point I would make is this: In using the irrigation method one should be very careful not to have the water too hot, nor yet too cold, as both are provocative of mischief.

In conclusion I would state that microscopical examinations were made in each of these cases, and all contained the gonococci of Neisser.

Discussion.

Dr. Drennen: Epidemics of vulvo-vaginitis in children of gonorrheal origin have occurred from time to time. These are sometimes brought about by taking children to public bath houses, and there using bath-house towels and other articles of toilet used in common. The disease can be found in children of from 1 to 14 years of age. Cases of juvenile gonorrhea in the male are usually caused by venereal indulgence, most probably with nurses; especially is this true in the South. I would suggest that the gonococcus in vulvo-vaginitis in childhood never invades the endometrium. The irrigation is, I think, the proper method. I find that the solution warm, but neither too hot nor too cold, is better, especially in vesical irrigation.

Dr. Smythe: I have just arrived, and so did not hear the paper. When I was in the general practice I saw a great many cases of vulvo-vaginitis in young girls, frequently non-gonorrheal. In urethritis of childhood it is usually gonorrheal, acquired from nurses. I do not think that irrigation is the proper method of treatment. I would rather give boric acid internally and use hot water injections, as well as holding the penis in a cup of hot water.

Dr. Moore: As to the cause of juvenile gonorrhea, ignorant negroes believe that if they can give another the gonorrhea they will get well themselves, consequently they fondle their boys. I do not believe in using a Valentine irrigator in these cases.

Dr. Malone: I am glad that Dr. Shinault reports microscopic examinations in his cases, for mistakes are very frequently made. In a case I had several doctors and quacks had diagnosed gonorrhea, pin worms, etc. I examined the urine and found that it was diabetic. I put the patient on proper treatment for diabetes, and she was cured in one month.

Dr. Jelks: I should like to report a case which seemed to be gonorrhea. I tore up some preputial adhesions, performed circumcision, and the discharge promptly ceased.

THERAPEUTICS OF QUININE.*

BY B. S. HALLIBURTON, M.D.

EDMUNDS, TENN.

Owing to its antiperiodic and antimiasmatic properties quinine finds its principal field of action in the malarial diseases, over which its power is that of a specific, this being admitted by all the leading authors of scientific medicine.

In intermittents, a 10 grain dose should be given in the sweating stage, and again five hours before the expected time of the next paroxysm. In the intervals, arsenic should be given, as quinine will cause a daily exacerbation of temperature, if long continued in large doses.

In remittents, quinine is best given in combination with one of the coal-tar antipyretics, in 4 to 5 gr. doses every two hours, until temperature is reduced to normal, or ringing in the ears is produced; then every four hours thereafter until the fever is well under control. Flint tells us that "time need not in any case be lost in resorting to cathartics or other measures preparatory to the administration of this antiperiodic remedy." I myself have found this simple treatment, together with the proper palliatives, as the case may demand, to be quite efficient in most all cases of remittent fever.

In pernicious intermittents and in pernicious remittents, the sulphate or bisulphate should be given during the paroxysm, and given in larger dose than in ordinary cases of this fever, in view of the vastly greater importance of immediately correcting the disease, and because the tolerance of the remedy is much greater. A scruple of the sulphate of quinine may be given at once and repeated again in three or four hours if no evidence of cinchonism is produced, and in such doses thereafter as the case may demand to maintain cinchonism until the time of the next paroxysm is passed. In case there be an inability to swallow, or of the stomach to

* Read before the Gibson County Medical Society, Trenton, Tenn., June, 1898.