2. As an Antiperiodic, or Anti-intermittent

No remedy approaches Peruvian bark in antiperiodic powers. There is scarcely a doubt that, for its peculiar properties in this respect, it is indebted exclusively to its alkaloid constituents, and that everything which bark can do, can be effected by quinia. Indeed, in consequence of being less offensive to the stomach, the latter is the more effective of the two, where a strong impression is necessary, or when the affection is complicated with gastric irritability. In all regularly intermittent or periodic diseases, quinia may be considered as an almost certain remedy; at least I do not remember to have met with a case which has not yielded to it, since the management of this medicine has been well understood. But it is not all diseases occurring paroxysmally that belong to the category here referred to. To come under the head of regular intermittent diseases, the affection must occur about the same hour, at the interval of a certain number of days, one, two, or more, without any positive or recognizable disease, in the period between the paroxysms, by which they can be reproduced. In other words, the complaint must be at once idiopathic, and regularly periodic. Hectic fever, therefore, though it has paroxysms closely resembling those of intermittent fever, does not belong to the class referred to; because it depends upon an ever-present organic source of irritation, and its paroxysms are irregular in their recurrence. Epilepsy and hysteria are equally excluded, though both paroxysmal, because often dependent on a constant though perhaps concealed lesion, and almost always more or less irregular. But even these affections, or imitations of them, when purely functional, and occurring at regular periods of one or a few days, will yield for a time to the antiperiodic treatment. Indeed this treatment is, in its nature, essentially temporary; its only effect being to guard the system against the recurring paroxysms, not to secure future immunity, when its direct influence has ceased. If, therefore, there should be some cause in operation capable of inducing a paroxysm of the disease, the patient is still liable to an attack after apparent cure, supposing the direct influence of the remedy to have been withdrawn. Hence, even in ordinary intermittent fevers, it very frequently happens that the paroxysms recur, at a somewhat varying period, after the suspension of the antiperiodic treatment. All that we can accomplish, then, by this treatment, is to prevent the recurring paroxysms so long as the remedy acts. If, in the mean time, the cause cease to operate, or the susceptibility to its influence no longer exist, when the chain of morbid association, or the force of habit is broken, a permanent cure is effected; if not, the disease is liable to return, and may continue to do so until the cause is at length removed, or the systern becomes insensible to its influence, as it does in time to noxious agencies in general, when not fatal in their effects, or applied in increased quantity or force.

Intermittent fever is a disease in which quinia exhibits, probably, its most extraordinary powers. Before the discovery of Peruvian bark, some of the forms of this affection were extremely embarrassing to physicians, and an obstinate quartan was scarcely less dreaded than pulmonary consumption. Afterwards it was found in general to be very manageable under the new remedy; but cases were now and then met with which resisted its influence, in consequence sometimes of insurmountable obstacles to its administration in the ordinary quantity, or to its retention when administered, and sometimes of the impossibility of introducing into the system a quantity large enough to meet the requisitions of the case. But, since the introduction of quinia into use, the disease may be considered as completely under command, so far at least as regards any single attack. The only requisitions are, that the remedy be administered in sufficient quantity, and at the proper time. If upon trial a certain amount is not found to answer, it must be increased; and no limitation should be put to this increase, except the production of the desired effect, or a reasonable apprehension of serious mischief to the patient. The general rule is to give enough to affect the cerebral centres decidedly, as indicated by the buzzing or roaring in the ears, or by a greater or less degree of deafness.

The question at once presents itself, whether any previous preparation is necessary, and, if any, what? Formerly, it was customary to anticipate the antiperiodic by an emetic. Experience has shown this to be unnecessary in the vast majority of instances. Should, however, the attack surprise the system with the stomach loaded, and evidences of gastric irritation at the same time exist, it might be advisable to aid nature in getting rid of the offending matter, by means of warm water, or warm chamomile tea drank freely, or if necessary by a dose of ipecacuanha. Ordinarily the only preliminary measure desirable is the evacuation of the bowels. In urgent cases, where it is important to produce the antiperiodic impression as soon as possible, even this may be dispensed with, and the administration of the quinia commenced at once. I think, however, that it is generally best to begin with a cathartic, in order to remove any possibly offending matter from the bowels, and unload the portal circulation, and thus promote the absorption of the medicine. If the liver is torpid, a portion of calomel or blue mass should be given with the cathartic.