QUININE AS AN ECBOLIC.

BY H. P. ROBERTS,

Surgeon 9th N.I., Baroda.

ON the 17th December I was sent for by Mrs. E. A., aged twenty-four. She complained of having "fever" (ague), which had begun the previous day, and though her attack was mild, as it had made her feel weak, she was very anxious to prevent a recurrence of it. She was expecting her third confinement in ten days, and was most emphatic-when questioned as to the correctness of her dates; in this case the nurse was not expected for ten days. The pulse was quick (110), and her face flushed. I ordered her two doses of quinine, three grains each, to be taken before the evening. At 10.30 P.M. I was again called, and found the labour pains had commenced. On entering the room she at once said to me, "The quinine you gave me has brought this on." On inquiry she informed me, in addition to her own sensations of being affected by the quinine, that the natives in India all attributed this action on the uterus to this drug.

She was delivered at 1·30 A.M.

I had taken no notice of her remark until I chanced to fall upon the suggestion of quinine being an ecbolic in a back number (July 1876) of the Practitioner. As is similarly remarked in Case I. given there, the labour may have been induced by the influence of the feverish attack, and my having prescribed quinine merely a coincidence-it seemed however worth noticing.

ON THE DESIRABILITY OF FORMALLY NAMING ANY EXISTING DIATHESIS IN CASES OF ACUTE : DISEASE.

BY T. CHURTON, M.B.,

Physician to the Leeds Public Dispensary.

Influence of Diathesis Admitted.-I do not propose to dwell upon, to illustrate, or to attempt to prove the influence of diathesis upon the course of acute disease, since this influence is generally asserted or admitted. When acute diseases linger, and are drawn out beyond the term of what is called their natural history, their doing so is usually explained by the circumstance that the patient has something wrong besidessome diathesis or dyscrasia. Not only so, but specific names are now often appended to acute diseases expressive of the influence of such diatheses or dyscrasias upon them. Thus we hear not only of syphilitic, but also of gouty and rheumatic iritis; of gouty bronchitis; of drunkard's pneumonia, and, more doubtfully, of gouty and of rheumatic pneumonia. Dr. Sturges tells us that "Dr. Todd, besides the simple disease, used to speak of pneumonia complicating gout and rheumatism, as well as of strumous, typhoid, and traumatic pneumonia." Dr. Sturges himself, writing of pneumonia, says: "The acme of the disease is to be expected within eight days, but complete recovery may be delayed by the feeble recuperative power of the individual, and by many other things;" and he also relates a case of rheumatic fever in which the joint inflammations (under strongly alkaline treatment) disappeared suddenly and were succeeded immediately by double pneumonia. Dr. Milner Fothergill, in his recently published book on Thera

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peutics, says, "At times a general condition may obtain that interferes with the repair of any part which has been affected with acute disease. Such conditions are notably found in gout, rheumatism, and syphilis;" and the same author says specifically “Even pneumonia may have a gouty origin."

It would be impossible in half an hour, or indeed in a very much longer time, to discuss or even cursorily to touch upon all the interesting questions which naturally arise in connection with this subject. Confining myself to the clinical aspect of acute disease, I shall refrain from attempting accurate definitions, and from minute pathological inquiries or explanations; and for the purposes of this paper I shall mean by "acute disease" any disease accompanied by exudation, cell-proliferation, connective-tissue hyperplasia, or even merely by hyperæmia, whose existence is, in an otherwise healthy body, of comparatively short duration. And by diathesis (which means simply state," whether good or bad), any abnormal state, physical, chemical, or vital, of the blood or of bioplasm, whether the latter be in its state of freedom in the blood or be deposited as tissue.

Diatheses liable to be overlooked. The influence of diathesis, then, is admitted, but inasmuch as it is not always in operation since a gouty man may have a non-gouty acute disease, and a syphilitic man an acute disease unaffected by his syphilitic taint and inasmuch as, also, even when it is in full force and operation, it has not yet obtained a distinct, habitual, and decided recognition in nomenclature, it is, there is reason to think, liable at times to be overlooked. It is true that men of penetration and experience do not often overlook it, but it is probable that if a second name were always and necessarily, and not merely occasionally and at individual discretion, added to the name of the acute disease, indicating the presence or the absence, as the case may be, of any pre-existing abnormal state of blood-plasma or tissue-plasma, then a diathesis in a state of activity would much less frequently be overlooked by any one, even when he is hurried or fatigued. If, I mean, it were never sufficient to say that a patient has pneumonia merely, any more than it is considered sufficient to say that he has iritis merely : if it were necessary that an adjective should always be added

indicating the kind of person (diathetically) who has the pneumonia-this latter consideration being often the most important element in determining the treatment. Many cases have impressed me with the conviction that such an adjectival addition should be expressly and constantly used.

Cases.-Pneumonia lithica.-A lady, aged sixty-two, of decidedly lithic diathesis, had pneumonia. One knee was somewhat swollen at the time of the attack. I saw the patient casually twice. The tongue was furred; pulse full, quick, and strong; skin hot; no cardiac distress; no great dyspnoea. Brandy, wine, eggs, milk, and beef-tea were being forced upon her, even against her will. The pneumonia was at first of no great extent. This treatment was continued, not without some remonstrance, and the patient died about the tenth day. That the treatment was injurious under the circumstances may be inferred from considering another case which occurred under my own more immediate observation, but which, from a difference in the locale of the acute disease, did not end fatally.

Arthritis lithica.-A tradesman's wife, aged fifty-five, had— not, fortunately, gouty pulmonitis, but gouty arthritis. She was treated in the usual way, but got rapidly worse, so that at last she positively seemed to be likely to die. Searching inquiry now disclosed the fact that her daughters, under the impression that it was necessary before all things to keep up her strength, had given her the strongest beef-tea-the extract, in short, of about two pounds of beef in the twenty-four hours, together with wine, milk, and other things; and this they had done in spite of the usual directions. The pulse was very feeble, and the strength seemed nearly gone, but a brisk purge of magnesia and colchicum, and a fruit diet with claret and water, soon restored the patient; and the value of the treatment being thus shown, it was acquiesced in, and she recovered completely; but if this patient had had pulmonitis lithica, instead of arthritis lithica, she would in all probability have died.

Pleuritis lithica.-A similar thing happened in the case of a child, aged four, the son of a country gentleman, who had pleuritic effusion. The more weak, thin, pallid, and listless he became, the more they pressed him with food, beef-tea, milk, eggs, &c. He passed much uric acid and lithates, still they had

persevered. It was with considerable difficulty they could be prevailed upon to adopt a restricted diet, chiefly of fruit; whereupon he recovered. He has not eaten any meat except game since, and he is now almost the healthiest and ruddiest child I know. His blood had been filled with uric acid, and that had prevented the removal of the anatomical disorder. He had, in fact, pleuritis lithica.

Remarks. These are examples of the ill effects in certain defined cases of the so-called restorative treatment of an acute disease, a treatment which may be all very well under some other conditions.

Pneumonia simplex. Thus, the daughter of the lady whose case is first related, had had pneumonia a year before; but it was of a totally different species-Pneumonia simplex—and she had been quite correctly treated for severe and perilous cardiac distress about the eighth day, at a time when one lung was entirely solid, by small doses of milk and brandy, or water and brandy, every three minutes for a whole night. She recovered; and perhaps, from want of some differentiating name, her case lent support to the "restorative treatment of pneumonia"a phrase which is still in use, though we are never tired of asserting that the patient, not the pneumonia, is to be treated.

The Syphilitic Diathesis.-Phthisis Syphilitica.-Lancereaux mentions a curious and well-known case in which the syphilitic diathesis was overlooked. An electuary was ordered for a phthisical patient, whose case was, however, considered hopeless. By mistake the patient got mercurial ointment, and took a piece as large as a nutmeg two or three times a day, and the end of it was that he was radically cured, greatly to the astonishment of everybody.

Hepatitis Syphilitica. -The following case, too, occurred to myself. A young married man, with a wife and two children, apparently in perfect health, had been under medical treatment for six weeks, his medicine having been frequently changed, but without effect. He was now greatly emaciated; he was sallow; his tongue was covered with creamy fur; all attempts to swallow food caused immediate vomiting; his speech was hesitating and tremulous. The epigastric and hypochondriac regions bulged considerably, and were occupied by an enlarged liver and,