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grain of pure strychnia being equal to onegrain of brucia. It must be rememberedthat now our Pharmacopoeia has givenus a formula from which we must expectuniformity in the preparation, and that asingle grain dissolved in two drachms ofdistilled vinegar, will afford a remedy ofwhich four or five drops will speedily pro-duce twitchings in a paralysed limb. Thereis a case on record of a lady for whomstrychnia was prescribed ; the dose not

being known, but which was diminished onoccasion of the following occurrence, to one-tenth of a grain, three times a-day. Soonafter taking the pills containing the strych-nia, in the morning, she was seized withspasm of the muscles about the larynx, andthose of one arm. She felt as if she wasstrangled. With much effort she mixedsome eau de Cologne with water, " snap-ped at it," and so swallowed it. She wasshortly relieved. The dose of strychnia Iwas repeated between breakfast and noon.The same symptoms were renewed; she feltand looked as if strangled. The muscleson each side of the larynx became tenselike chords. She was again relieved byeau de Cologne, which she took hastily, asbefore.The mode of ascertaining that strychnia

is pure, is by adding to the mixture a smallquantity of nitric acid; the deeper the redwhich is produced, the larger must be thequantity of the brucia present, and nostrychnia should be medicinally employedthat is tinged more deeply than a pale red-dish-yellow hue by the nitric acid.

ON THE CURE OF

INTERMITTENT FEVER,BY

PURGATIVES AND QUININE,AND THE EMPLOYMENT OF BLEEDING AS AN

ACCESSORY.

To the Editor of THE LANCET.SIR:-I have this morning read a commu-

nication in THE LANCET, from Mr. Macken-zie, of Kilsby, 11 own bleeding in the coldstage of intermittent fever," wherein a caseis reported, successfully treated by venesec-tion and purgatives. Its author regrets thatbleeding is not more generally practisedthan it is.

For my own part I must confess that,though a great friend to theloncet, I stronglyobject to its employment, under ordinarycircumstances, in the treatment of agnes.I am confident that with many, particularlythose practising in tropical countries, bleed-ing has become too gene1’ltl and indiscrimi-nate. If an intermittent fever should occurafter a preliminary indisposition, one cannot

he too careful in the use of the lancet.* Inthe succeeding observations I shall endea.vour to discriminate between those cases

which require bloodletting for their cure,and those which are curable by othermeans, wherein bleeding, in some instances,would be not only unnecessary, but inju.rious.

It is a fact very well known that, in hotcountries more particularly, ague is oftenaccompanied with visceral disease, assum-ing more or less an inflammatory character.The organs mostly affected are the liver andthe spleen ; the latter, though comparativelyseldom affected in temperate climates, isvery commonly the seat of disease withinthe tropics.Should we, then, be consulted by an indi.

vidual who tells us that he has ague, andwe detect in him, by a careful manual exa-mination of the abdomen, liver, or spleeu,disease, we could hardly expect to curehim of his ague, unless we directed our at.tention to the state of the internal viscera,and prescribed means which were adequateto their relief. Bleeding in such a case

would be indispensable. Those who arefavourable to v. s. at the commencement ofthe rigor, do not employ it with the idea ofrelieving any local disease that may co-exist,but with the view of preventing a return ofthe paroxysm, and which I verily believe,after no inconsiderable experience in thetreatment of intermittent fevers, to be as

quickly and permanently obtained by pur-sratives and auinine alone.

It was in Calcutta, A. D. 1834, that I firstsaw the practice adopted, by the late Mr.

Twining. He strongly recommended me totry it. I had then just arrived in India,and I determined to follow the recommenda-tion of my friend. After having done so fora couple of months, in almost every casethat came under my care, I began to dislikeso routine a measure, and determined to as-certain for myself the utility of the pro-ceeding.

I quickly found that bleeding, thoughperformed in strict compliance with therules laid down by Mr. Twining, was at-

tended with no appreciable advantage; andwhen practised on the effeminate Hindoo itwas decidedly injurious. I did not findthat those who were bled recovered soonerthan those who were not ; neither did I findthat the former were less liable to a relapsethan the latter.

I have treated succe1Bsfullya a great niini-ber of cases of ague with purgatives andquinine alone, and have never found it ne-

* Vide page 577, et se1., in " Twining’s

Illustrations of the more important Diseasesof Bengal," where are to be found some ju-dicious observations on bleeding in inter-mittent fevei-s, cautioning the practitioneragainst its general adoption,

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cessary to bleed, where there were not otherand important indications requiring that.evacuant. In those cases where it has hap-pened that the disease has been cured bybleeding, after the more usual remedies havebeen said to fail, I cannot help thinking thatthere has existed some visceral diseasewhich had been overlooked ; and if so, wecan easily understand why v. s. proved soefficacious. For if, under ordinary eircuin-stances, bloodletting be so valuable a the.rapeutic agent, when performed on the ac-cession of the cold fit, why do not its advo-cates trust to it alone, and not prescribeadditional remedies to succeed it? If bleed-ing be practised alone, and purgatives and Iquinine be not employed, it will be foundto fail, but if purgatives and quinine beused, independently of bleeding, we shallthen invariably succeed. If v. s. be resort-ed to, and followed by the use of purgativesand quinine, as is generally the case, thesuccessful issue must be attributed to theremedies which have succeeded the opera-tion and not to the operation itself.

I speak this with confidence, after havingcarefully witnessed in my own practiceabroad, particularly when in China, whereit was by no means limited, the effects ofeither mode of treatment, both singly and Iconjbintly.* I need hardly observe, that Iam most perfectly convinced of the practi-cability of curing intermittent fever, notcomplicated with visceral disease, as quicklyand permanently without bleeding as with it.

It happened on board the ffioffard, for-merly one of the East India Company’sships, where I officiated as surgeon, thatour worthy skipper refused to supply forthe ship’s use, in spite of my remonstrances,a further stock of quinine, on leavingChina, declaring, that at sea we should11 have no sickness;" and t" what, then,would be the good of physic ?" It happen-ed that at Macao we were detained, whereI should suppose we were exposed to a freshsource of malaria; the consequence was,that we had scarcely lost sight of land,before four of those men who had but somedays before experienced ague at Whompoa,were attacked again, and, at last, we mus-tered ten cases, without having any quinineon board. From my previous experience of1’, s. I had lost all confidence in it, but atlength, knowing not what else to do, I wasalmost driven to employ it; but, alas! withno better effect than before. Desirous, ofcourse, to do all in my power for these poormen (two of whom were officers, and onethe son of your able contemporary, Dr.James Johnson), in addition to more ordi-nary means, I administered emetics, in the

* A mere fraction of a medical man’spractice when in a foreign port, is confinedto his own ship, as none but the largest,and those ships which carry passengers,have surgeons.

cold stage, and employed cold affusion, butto little purpose.

Bleeding, cold affusion, and emetics, Ihave considered to be of pretty equal utilityin the treatment of intermittent fevers, occa-sionally rendering the paroxysm less severeand protracted.On our arrival at St. Helena, I procured

some quinine, which, together with otheradjuvants, soon restored our invalids to

health, although by this time they were suf-fering from local dropsies, &c., &c., the

sequences of ague.In a paper lately published in the 11 Me-

dical Gazette," by Mr. Nash, after alludingto the infrequent bloodletting required bythe native Indian, that gentleman has ob-served,-" Even in Europeans, however,bleeding in the cold stage of ague is not, asfar as my experience goes, an admissiblepractice. The late Dr. Twining, of Cal-cutta, a man remarkable for his accuracy ofdiagnosis and skilful treatment of disease,tried the experiment pretty largely amongthe Europeans in the General Hospital atCalcutta, but I did not think that the bene-fits derived from the practice were sufficientto cause its adoption. The disease is perfectlyunder control by other means, and the lossof blood only diminishes the general powersof the constitution, at the very time that theyare required to bear up against the returningtendency of the complaint."Allow me, in conclusion, to observe, that

purgative medicines, especially calomel, areindispensable in ague. Without them qui-nine is only of occasional service.The captain of a small ship lying off

Whompoa, asked me how he could cure hismen of the ague ; they all of them, be said,had it but himself. He told me that he had

given to each of them large and frequently-repeated doses of quinine, but it did nogood. I desired him to give to each man afull dose of calomel alldjalap, followed bya sharp dose of Epsom salts and senna, andto discontinue the quinine until after theoperation of the purgatives. The resultwas successful; they were all well in a fewdays. This fact points out the necessity ofunloading the alimentary canal, thereby re-moving morbid secretions, and improvingthe secreting and excreting functions.Many mild cases I have found curable by

purgatives only, which operate, perhaps, byimproving the general powers of the con-stitution, and thus enabling it to withstandthe unhealthy influence of malaria.Hoping that yon will consider these ob-

servations not unworthy the columns of THELANCET, and with many apologies for thelength to which they have unintentionallyextended, I remain, Sir, your obedient ser-vant, &c.

JAMES GEORGE DAVEY, M.R.C.S.L., &c.3, Mile-end Terrace, Portsmouth,

Aug, 26, 1837.3 R