Typhoid or enteric fever is also among the diseases in which this method of treatment has been employed. Some have supposed that, like miasmatic fever, this affection could be promptly arrested, strangled as it were, by large doses of quinia. A knowledge of its pathology, one would imagine, should be sufficient to guard against this error; for that it is an error has, I think, been abundantly shown by experience. Sometimes, it is true, the disease seems to be mixed with remittent fever, having regular paroxysms, recurring at a particular hour every day, probably owing to the simultaneous action of the causes of the two complaints. In such cases, as I know from observation, quinia will check the paroxysms, and remove the regular remittent character; but the febrile affection will still march on, with its characteristic phenomena, to its regular termination. In France, sulphate of quinia in large doses has been used, not with a view to the prompt suppression of the disease, but in order to diminish the fever, lessen the danger, and lead to a speedier issue. M. Briquet, who employed it largely, states, as the result of his observation, that the pulse is moderated under its influence, the heat of skin diminished, and the cerebral symptoms very much alleviated; and on the whole, believes that this treatment will compare very favourably with any other which has been adopted. An apparently curious point, in his experience, is the effect of the medicine in diminishing stupor, quieting delirium, and otherwise favourably influencing the head affection. But the cerebral symptoms in this complaint are not those of active congestion or inflammation. They have probably a double origin, depending, in part, upon the depressing influence of the cause upon the brain, either immediately, or through the instrumentality of the diseased blood, and partly upon the irritating influence of the diseased bowels upon the cerebral centres. Now, quinia is calculated to obviate both these effects. By its excitant influence, it may counteract the operation of the depressing cause, and thus correct in some degree the characteristic stupor; while, in large doses, through an excess of the same influence on the organic centres, it renders them less impressible by the diseased glands of Peyer. We might, therefore, expect some favourable effects from large doses of quinia; but, though I have given the alkaloid often and freely in this complaint, I have never found from it any other advantage than a moderate supporting effect in the low states of the disease; and have often been compelled to omit it by an aggravation of the symptoms. I have certainly never seen it cure a case of the disease. Nor can the results obtained by M. Briquet be considered remarkably favourable, when judged of by his statistical report. Of forty-three cases of a serious character, including all that came under their notice, treated by himself and M. Blache, either in part or exclusively with sulphate of quinia, eight terminated fatally; and, of these eight, four, on post-mortem examination, exhibited undoubted signs of meningitis. {Trait. Therap. du Quinq., pp. 383 and 385.) Now, the proportion of deaths is here much greater than we habitually meet with in the Pennsylvania Hospital (see my work on the Practice of Medicine, 5th ed., i. 354), even if the serious cases only be taken into account; and the number of cases, four out of eight, in which signs of meningitis were discovered, is far beyond the usual proportion, under any ordinary treatment. The inference is fair, that the general result of the heroic treatment with sulphate of quinia is unfavourable, and that it causes death, either by directly inducing meningitis, or by aggravating a tendency to that affection already existing; which is exactly what might have been anticipated, from the views here inculcated of the action of quinia on the brain.*

In typhus fever, the abortive treatment by sulphate of quinia has been recommended strongly by Robert Dundas, of Liverpool; and has been tried with success by other British practitioners. Among those who report most strongly in its favour is Mr. J. O. Fletcher, who found it very effectual in cases of pure typhus, but not in those complicated with ulcerated bowels, in other words, not in typhoid fever. (Lond. Med. Times and Gaz., vi. 422.) As a tonic, Peruvian bark has long been an established remedy in typhus fever; but the idea of employing it in large doses, with the view of speedily arresting the disease, is, so far as I know, of recent origin. Though I have used it much in the former capacity, I have no experience with it in large doses, given at the commencement of the fever, with a view to a direct febrifuge effect, and have no right, therefore, to speak decidedly on this point; but, if the humoral views of the pathology of this disease now prevailing are correct, that it depends, namely, on a poison which enters the circulation, and alters the state of the blood, depraving that fluid, and causing the generation within the system, and elimination from it, of a poisonous matter like itself, we know of no properties in quinia which should enable it to correct this condition of things; and, though by its secondary sedative influence it may suppress the febrile phenomena, it would be considered, with these views, as not likely to eradicate the disease. If it has the power of arresting that quasi zymotic action in the blood, which is supposed to characterize contagious diseases, it ought to be competent to the interruption of the course of smallpox, measles, and scarlatina; an influence which would scarcely be claimed for it by the most sanguine.

Petechial or spoiled fever, or, as it is frequently called, malignant cerebrospinal meningitis, is one of the low forms of fever in which quinia appears to act most favourably, if confidence can be placed in testimony. Given freely in the initial stage, it is said often very happily to dissipate the more alarming symptoms, and allow the disease to be conducted to a favourable issue. My own experience with it is confined to a single case, in which, in connection with morphia, it appeared to act most happily.