ON THE 
rREATMENT OF INTERMITTENT FEVER 
BY TH3 
HYPODERMIC INJECTION OF QUININE. 
BY 
FREDERIC D. RENTE, M. D., 
MEMBER OP THE BOARD OP MANAGERS OP THE HUDSON RIVER STATE HOSPITAL ; OP THE MEDICAL 
SOCIETY OP THE COUNTY OP NEW YORK; OP THE MEDICAL SOCIETY OP DUTCHESS 
COUNTY, N. Y. ; OP THE PATHOLOGICAL SOCIETY OP NEW YORK; HONOR- 
ARY MEMBER OP THE MEDICAL SOCIETY OP NORTH CAROLINA^ 
CORRESPONDING MEMBER OP THE MEDICO-LEGAL 
SOCIETY OP NEW YORK, ETC., ETC. 
[REPRINTED FROM THE NEW YORK MEDICAL JOURNAL, MARCH, 1874 ] 
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1874. PROSPECTUS FOR 1874. 
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D. APPLETON & CO., 549 & 551 Broadway, N. T. ON THE 
TREATMENT OF INTERMITTENT FEYER 
THE 
HYPODERMIC INJECTION OF QUININE 
BY 
FREDERIC D. LENTE, M. D., 
MEMBER OF THE BOARD OP MANAGERS OF THE HUDSON RIVER STATE HOSPITAL ; OP THE MEDICAL 
SOCIETY OP THE COUNTY OP NEW YORK; OP THE MEDICAL SOCIETY OP DUTCHESS 
COUNTY, N. Y. ; OP THE PATHOLOGICAL SOCIETY OP NEW YORK; HONOR- 
ARY MEMBER OP THE MEDICAL SOCIETY OP NORTH CAROLINA; 
CORRESPONDING MEMBER OP THE MEDICO-LEGAL 
SOCIETY OP NEW YORK, ETC., ETC. 
[REPRINTED FROM TEE NEW YORE MEDICAL JOURNAL, MARCH, 1874 ] 
NEW YORK: 
D. APPLETON AND COMPANY, 
549 & 551 BEOADWAY. 
1874. OH THE TREATMENT OF INTERMITTENT FE- 
VER BY THE HYPODERMIC INJECTION OF 
QUININE.1 
The author of an able review of works on hypodermic 
medication, in the American Journal of Medical /Science, 
remarks: “ In the treatment of malarious fever, hypodermic 
medication bids fair to yield as brilliant and substantial re- 
sults as for any other disease. There certainly need be no 
great delay in deciding its merits, and fixing any detail of 
treatment. As in many sections of our country malarious 
fevers are the prevailing diseases during a considerable por- 
tion of the year, there is abundant opportunity for trial, as 
there will be an overflowing measure of benefit resulting, 
should the observations already published be substantiated.” 
He adds: “We think it would be difficult to exaggerate the 
importance of this improvement in our art to those portions of 
our country scourged by malaria, and we cannot refrain from 
again urging an investigation of its merits upon the profession, 
requiring as it does no complicated apparatus, no trained skill 
in delicate manipulation, but simply a spirit of enterprise, 
careful observation, and candid report of results.” 
Being fully in accord with the sentiments above expressed, 
I have, for the past two years, been endeavoring to surmount 
some of the difficulties attending the practical application of 
this method of treatment, and to test the value of the reports 
heretofore published ; and now present the results of my un- 
1 Read before the Dutchess County Medical Society, January 14,1874. 4 
TREATMENT OF INTERMITTENT FEYER BY 
finished labor in this direction, merely as a contribution to 
the work, being fully alive to the fact that my experiments, 
though more extensive than any yet published, are not suffi- 
ciently so to settle the question as to its relative value, or the 
details of its execution. 
It appears that Dr. Chassaud, of Smyrna, was the first ex- 
perimenter with the hypodermic use of quinine. This was 
probably in 1861 or 1862; yet, after the lapse of eleven or 
twelve years, we have only occasional and meagre reports of 
its employment, and evidently very little faith among the 
profession in its safety or efficiency. This has arisen probably 
from at least two causes : one, the rose-colored hue of the 
early reports;1 but principally the unpleasant accidents which 
have generally followed the injection of the solutions usually 
employed by physicians during the past few years. It has 
been my aim, therefore, to properly estimate the true value 
of the method in intermittents, and to overcome, by exten- 
sive trial, the pharmaceutical obstruction to its more general 
adoption. 
Dr. Chassaud reports that, “ of one hundred and fifty cases, 
he saw but one relapse after three months, using generally but 
a single injection.” “ Gfoudas reported fifteen cases, with like 
result. Eulenberg reports two cases of arrest of the cold 
stage by twTo grains ; and reports twTo cases in which a single 
injection in the apyrexia checked the disease permanently.” 
“We have, in two instances,” says the reporter (American 
Journal of Medical Science) above referred to, “ injected that 
amount of quinine an hour before the chill, and put a stop to 
the disease.” Dr. James McCraith, surgeon to the Smyrna 
and Aiden Railroad, reported to the Royal Medical and Chi- 
rurgical Society, that he had found it very useful in the “ per- 
nicious intermittents,” and gave one case of an alarming char- 
acter, where three and a half grains produced a rapid rescue 
from coma and impending death. Dr. Moore, of the Bombay 
1 The fact that the cases reported were mostly in hospital practice will 
account for the great apparent success, perhaps; as an hypodermic injection 
of even four or five grains will generally check the disease for two or three 
weeks, and as patients are not apt to ho kept in hospital long after the 
symptoms of disease disappear, the cases would he marked cured. IIYPODEKMIC INJECTION OE QUININE. 
5 
Hospital, reports its 'use in thirty cases of intermittent, and 
some cases of remittent, with “ almost invariable success.” In 
intermittents, he states that one injection sufficed, while, in 
remittents, he employs five or six. Dr. Greene, of Americas, 
Ga., in an article on this subject in the Louisville Medical 
Journal, 1871, speaks highly of the hypodermic use of qui- 
nine, but has seen “ such serious inflammation and sloughing 
follow its use ” as to cause him to discard it except in danger- 
ous “ congestive chills.” But he expresses the hope that some 
preparation of the drug may be devised which will render it 
more generally applicable. The reason of his ill success is 
evident from the composition of his formula. The late Dr. 
IT. D. Bulldey tried this plan in the New York Hospital, 
in some cases, and reported them at a meeting of the New 
York Academy of Medicine in 1866. He stated that he had 
the most gratifying results, “ especially in pernicious inter- 
mittents from the South.” Ilis colleague, my friend Gouver- 
neur M. Smith, M. D., according to Dr. Bulkley’s report, also 
used this method in the same hospital, “ with most gratifying 
results.” Dr. Otto’s experience will be noticed farther on. I 
have been told, by some of the resident medical officers of 
the Bellevue Hospital, New York, of some trials of this meth- 
od there, but have never been able to get any details; and 
they did not seem to be impressed with its success, especially 
in pernicious fever, in which it was almost exclusively used. 
But the cases were, as I understand, of a rather desperate char- 
acter. It would appear that, up to the present time, almost 
all the published experiments with this method have been 
carried on in public institutions; and there seems to be a 
general impression that it will admit of a very limited intro- 
duction into private practice. The experience of the writer 
will show that this is not correct. With patients who are 
kept in a proper state of discipline, and by judicious manage- 
ment, nine-tenths will submit to one injection at least; and, 
among those who are victims to repeated attacks of fever, who 
have exhausted a variety of remedies, and their own patience 
also, who are suffering from the demoralizing influence of 
malarial toxaemia, with no “ let-up ” to its painful symptoms, 
there will be no hesitation when the treatment is proposed, (3 
TREATMENT OF INTERMITTENT FEVER BY 
with a proper explanation of its modus ojoerandi, even though 
they or their acquaintances may have suffered from local 
troubles resulting from it. I have injected many patients this 
year who suffered from troublesome inflammation and abscess 
last year. 
Let us first consider the accidents which are alleged to 
have occurred and to be liable to occur from this treatment. 
Inflammation of a circumscribed character, abscess, and slough- 
ing, have frequently followed this procedure, and to such an 
extent as to have deterred most physicians from resorting to 
it, although many have been anxious to do so. Even tetanus 
has been charged to it. Notwithstanding the very favorable 
reports from tropical regions referred to, Dr. Maclean, of Net- 
ley Hospital, reports that, “ of four cases in the hospital who 
had been thus treated, three had troublesome ulceration.” Of 
the last one hundred cases reported in the Indian Medical 
Gazette, sixteen are said to have suffered from “ ulcerations.” 
The nature of these is not described. Sixty-eight of the cases 
are reported “ cured.” I have heard and read of cases where 
sloughing occurred, laying bare the muscles, etc.; and I have 
had two slight sphacelations in my own practice, one quite 
tedious, the other a regular “ dry gangrene,” attended, from 
first to last, by perfect anaesthesia of the part; an incision 
giving rise to a hard, sloughy mass (on the thigh) with a rapid 
and painless healing of the wound ; the patient caring little 
about it, and ready at any time to submit to the operation 
again, which he had already submitted to several times with 
perfect impunity. Last year, when I was a novice in the 
method, and experimenting with solutions of various compo- 
sition, I had many cases of inflammation and abscess, some of 
them exceedingly protracted and very annoying. Indeed, the 
inflammatory process, set up by solutions of quinine, and often 
by morphine also, and by other fluids, is peculiar. In many 
cases, days and even weeks may elapse before any marked 
trouble occurs, when a slow form of inflammation is set up, 
which results in a chronic abscess very little disposed to dis- 
charge spontaneously. In other cases, a tender induration 
merely remains for weeks or months, not causing any serious 
annoyance, and the soreness sometimes subsiding for days, to HYPODERMIC INJECTION OF QUININE. 
7 
reappear again and again. The same solution, injected into a 
dozen patients, and perhaps in some of them in several places, 
may he perfectly harmless in a majority, hut give rise to very 
troublesome sequelce in a certain number; the general condi- 
tion of the subjects being the same, or very likely of a more 
unfavorable character in those escaping the inflammatory 
trouble. I have said that tetanus has been charged to hypo- 
dermic injection of quinine; and, as the slightest probability 
of this would be an insuperable obstacle to the employment 
of this method, the allegation is worthy of notice. Two cases 
are reported in the Indian Medical Gazette of 1873 by a 
Dr. Odevaine, in which he injected a solution of quinine, which 
was followed by abscess and fatal tetanus. M. Arnold, of Al- 
geria, also reported two cases of the same kind a few years 
since. I have heard of no such occurrences in this country, and 
it is well to remember that there are certain localities, mostly 
tropical, where tetanus occurs as a very common incident 
from the most trivial wounds ; and even idiopathically, from 
exposure to damp, or sudden check of perspiration. I have 
elsewhere discussed this subject.1 It is needless to say that it 
is the wound and abscess in those cases, and not the quinine- 
injection, which caused the disease. Still, in such localities, 
no prudent physician would subject his patient to such a risk. 
A properly-prepared solution of quinine is, of course, the 
important desideratum, and several were proposed to me, as 
having given satisfaction, but which were found to be imprac- 
ticable. As an example of the extraordinary mixtures which 
have been highly recommended for hypodermic injection, I 
quote from the (London) Practitioner, for September, 1872, 
one by Dr. Otto, given in Le Mouvement Medical: “ The 
quinine,” he says, “shouldbe dissolved in ether, which should 
then be filtered and allowed to evaporate to some extent, so that 
more concentrated solution may be obtained.” Now, quinine 
is so nearly insoluble in ether that, for all practical purposes, 
it may be so considered. Prof. Maclean, of Netley Hos- 
pital, recommends an equally impracticable solution. In his 
report on the hypodermic injection of quinine, which was pub- 
1 Article on “Jamaica,” in New Yobs: Medical Journal, September, 
1868. 8 
TREATMENT OF INTERMITTENT FEYER BY 
lished officially in India, he says : “ It is quite possible, with a 
little care, to inject six grains of the salt (sulphate of quinine) 
in twelve minims of water, without the aid of any acid. The 
proceeding is very simple. Three or six grains are placed in 
a watch-glass, previously warmed ; to this, twelve minims of 
distilled water are added, and a moderate degree of heat ap- 
plied, with a spirit-lamp, for a second or two.” Then he pro- 
ceeds to give minute directions, as to the warming of the 
syringe, the size of the trocar, etc., which I do not transcribe, 
as I doubt if any one will be able to get the solution ready. 
The mass will be found to be a semi-fluid paste before heating, 
and less fluid after. If we could, in this way, get six grains in 
sixty drops of water, it would be superior to any solution 
which I have heard of, or been able to produce by long ex- 
periment. Dr. Moore says : “ I have used the strongest solu- 
tion which can be prepared, viz., thirty grains quinine, eight 
or ten drops of dilute sulphuric acid, and half an ounce of 
water.” Dr. Lorent uses acetate of quinine, of which he says, 
“ thirty grains will dissolve, by the aid of heat, in two and a 
half drachms of water.” Dr. Greene’s solution, which gave him 
so much trouble, is: “ Jfr. Quin, sulph. 3ss; acid, sulph. dil. 
gtt. x; aquae bul. § ss M.” The formula employed in the 
Hew York Hospital is: “ ID Quin, disulph. 3 j; acid, sulph. dil. 
gtt. 1; aquae font. §j. Solve.” Dr. Constantine Paul highly 
recommends glycerine as a solvent. The last suggestion has 
a great advantage over the others, in promoting the solubility 
of the drug with very little acid, and retaining it in perfect solu- 
tion. But, unfortunately, it is irritating to the cellular tissue, 
very slow of absorption by it, and very prone to flow away 
from the small puncture after its injection. After failing with 
all the solutions hitherto recommended, I applied to a practi- 
cal chemist, in Hew York, to prepare for me a solution which 
should contain “ ten grains of the salt to the drachm, with the 
least possible amount of acid which will retain it in solution.” 
Ilis solution, as he stated, contained a minim of strong, or four- 
teen minims of diluted, sulphuric acid to the drachm. Hot- 
withstanding this amount of acid (about four times the amount 
used by Dr. Moore, six times that of Dr. Greene, and about 
seventy per cent, more than the Hew York Hospital formula), HYPODERMIC INJECTION OF QUININE. 
9 
his solution was not permanent, but deposited crystals abun- 
dantly, unless kept at a temperature of 70° or 75° Fahr. It 
was, therefore, generally necessary, in cool weather, to heat it 
before using. How previous writers have managed, therefore, 
to prevent their solutions from depositing, or to use them with- 
out the aid of heat, is a mystery to me. As regards Dr. 
Lorent’s solution, I have not tried it, for I had so uniformly 
failed with formulae for dissolving the different salts of qui- 
nine without acid, so confidently recommended, that I had no 
greater faith in the solubility of the acetate than of the bro- 
mide, the bisulphate, the hydrochlorate, etc. Before using the 
ten-grain solution, I had tried a much weaker one, only four 
grains to the drachm. But, as the injection of even pure 
water into the areolar tissue is quite irritating, it was a 
nuisance, both to the patient and physician, to be obliged to 
inject a drachm of fluid in order to introduce so small a quan- 
tity of the drug into the system. After using the stronger 
solution for some weeks, and finding that I was getting a rather 
inconvenient crop of inflammation, abscesses, and sloughs, and 
creating a damaging but very natural prejudice against a 
very valuable remedial measure, I reduced the strength to 
five grains to the drachm; but the smallness of the dose and 
the still frequent occurrence of inflammation and tumefaction 
induced a trial of some further modification. I had also been 
annoyed by a cryptogainic deposit in the solution after stand- 
ing for a short time; and, with a view to obviate this, and 
also to test the efficacy of Lister’s antiseptic plan on the cellu- 
lar tissue, carbolic acid was added to the solution; and, after 
some trials, the following formula was adopted, and has been 
used ever since: 1$. Quinse disulph. gr. 1; acid, sulphuric, 
dilut. TT[c.; aquse font. §j; acid, carbolic., liq., Tttv. Solve. 
Place the quinine and water in a porcelain dish, over a spirit- 
lamp, heat to the boiling-point, and add the sulphuric acid, 
stirring with a wooden spatula. Filter at once into a bottle 
and add the carbolic acid. This gives full six grains to the 
drachm. Even this solution will deposit some crystals at a 
temperature of 50° ; and, of course, at or below that tem- 
perature requires to be warmed before using. The carbolic 
acid also, I think, alleviates the pain of the injection, as there 10 
TREATMENT OF INTERMITTENT FEVER BY 
is but little complaint, in most cases, after the first few drops. 
I can recommend this with considerable confidence, so far as 
danger of local difficulty is concerned, since it has been used by 
myself aud my various assistants at least one hundred and fifty 
times, or over three hundred insertions (each hypodermic dose 
consisting of at least two injections). Neither have I, nor any 
of the gentlemen who have used it under my direction, had 
any serious trouble with it.1 In one case, after using it twice, 
it produced each time a diffuse cellular inflammation of the 
arm, which yielded slowly to cold-water applications, and I de- 
sisted, although the patient was anxious to submit to another 
trial, so far superior did she find this method to that by the 
mouth. In another exceptional case, a singular effect was pro- 
duced, already noticed in this paper—anaesthesia of the part, 
followed by dry gangrene of a small mass of cellular tissue. 
This was the fourth injection of this patient, or the eighth 
insertion, none of the others giving any trouble whatever. 
Patients frequently experience a numbness of the part, some- 
times lasting weeks after the operation, possibly from the 
effect of the carbolic acid. The injected part is usually tender 
for a few days after injection, when accidentally touched ; some- 
times inconveniently so, when the patient is at manual labor 
(on this account, it is better to select the left arm), but it rarely 
incapacitates a laborer, even for half a day. Since this solu- 
tion has been used, I have met with full as many cases of 
trouble arising from injections of morphine, though so much 
smaller in bulk, as from it. All hypodermic injections, how- 
ever small, will occasionally cause inflammation, abscess, and 
even sloughing, sometimes of a persistent character. 
The question of the proper strength and composition of the 
solution is a vital one, as regards the ultimate success of this 
valuable mode of treatment, and, as it cannot be considered at 
all settled, I have already dilated considerably on this point, 
and would remark further that the inconvenience, slight 
1 Dr. Murdock has used this method to a moderate extent, and his expe- 
rience is incorporated with mine. I have, at different times, been assisted 
by Dr. A. A. Smith, of New York, and by Drs. Farmington, Griffith, and 
Young, of the resident staff of Bellevue Hospital, who are, I understand, 
using this solution now in that hospital. IIYPODERMIC INJECTION OF QUININE. 
11 
though it is in a majority of cases, of introducing the needle 
two and occasionally three times at a sitting, and inserting 
sixty to ninety minims of fluid more or less irritating, is suffi- 
cient to induce the hope that a solution equally safe will be 
devised, which shall contain two or three times as much of the 
drug. It is true that, by the aid of heat, applied at the time 
of the injection, double the quantity in the same amount of 
fluid may be used; and this brings up the question of con- 
centration of the solution, which most writers have consid- 
ered essential. Tw’O ideas seem prominently to occupy the 
minds of those who have employed this method, both of which 
are probably erroneous and mischievous : one, that the solution 
cannot be too concentrated, provided little or no acid be used ; 
the other, that the acid is the principal or only cause of the 
serious accidents sometimes attending the injections. How, it 
will be found that, in cases of local trouble, more than one 
cause is in operation, sometimes several. Thus the delay in 
the absorption of the fluid, one portion of areolar tissue 
only a few inches from another absorbing more readily; this 
delay being also sometimes attributable to the imperfect 
solution of the salt, and the latter the result usually of using 
too little acid. The character and condition also of the 
instrument is perhaps a not infrequent cause. The manner 
of performing the operation, slight as it is, has its influence. 
Dr. Moore says, “ I insist on a perfectly clear solution of the 
alkaloid,” and he might have added, at a temperature of 60 
Fahr. I am inclined to think that the acid, so largely diluted 
as it is, even in the solution advocated here, 1.7 per cent, of 
the undiluted, can have no injurious effect on the tissues 
greater than that of the other agents employed, if as great, and 
that there is more danger in using too little than too much. 
The longer the solution remains in contact with the areolar 
tisue, the greater the danger of inflammation ; and the more 
complete the solution, the more rapid, cceteris paribus, the ab- 
sorption. Here is a very recent case in illustration of this 
fact: A young girl wTas injected live days ago, with two syr- 
ingefuls of solution. One passed readily into the circula- 
tion ; the other remained, and was disposed to exude through 
the puncture; the Anger was kept on for some time to pre- 12 
TREATMENT OF INTERMITTENT FEVER BY 
vent it; blit tlie fluid passed away for some hours, drop by 
drop. The parts about this puncture are much inflamed, and, 
notwithstanding the application of cold, there is still some 
redness and induration, while the other puncture has given no 
trouble at all. 
Having settled upon a proper solution as far as present ex- 
perience enables us, there are some precautions advisable. It 
is important to have a gold needle, not one merely gilded. 
Messrs. Tiemann & Co. prepare them very skillfully, and, with 
care, they seldom require sharpening, which may easily be done 
on a fine hone. The syringe and needle should be washed out 
after each operation, and the piston frequently oiled, as it is 
both stiffened and rotted by the solution. The outer and an- 
terior portion of the arm, not too near the joints, are usually 
chosen for the insertions, although the outer and upper por- 
tion of the thigh present desirable localities. We have, how- 
ever, injected all parts of the body, in cases where repeated in- 
jections were required. I usually make the two punctures two 
and a half to three inches apart, so that the wet application, 
which is often desirable, to prevent inflammation, may cover 
both. The injection should be made with deliberation. The 
first few drops cause more or less severe smarting, and I wait 
until this ceases, or nearly ceases, perhaps half a minute or a 
minute; then continue slowly, drop by drop, as fast as the 
patient can endure it, without inconvenient pain, being guided 
also somewhat by the rapidity with which absorption takes 
place, judging by the greater or less elevation of the integu- 
ment around the puncture. As soon as the needle is with- 
drawn, I cause the patient or a by-stander to put the finger 
over the puncture for two or three minutes, to prevent the 
fluid from exuding. In case of threatened inflammation, or 
much soreness, I direct the patient to bind on a wet folded 
handkerchief or pledget of lint as a precautionary measure. 
As regards the best time for the operation, the general im- 
pression seems to be that it should be done just previous to the 
expected paroxysm, and Dr. Moore, of Bombay, says: “ The 
best time is shortly before the cold fit; but it may be done 
during the cold stage with the effect of lessening and some- 
times stopping the whole paroxysm.” I can corroborate the HYPODERMIC INJECTION OF QUININE. 
13 
last observation, and shall subjoin some cases in illustration of 
this important point.1 I am not fully prepared, as yet, to say 
whether there may not be an advantage as regards the ulti- 
mate effect of the operation, in following the prevalent notion. 
But, it so often happens that the severe train of symptoms 
attending a paroxysm of epidemic ague is mitigated, even ar- 
rested by the injection on the spot, that, when convenient, I 
always give the patient the chance. But, as a general rule, 
I have injected without any reference to the date of the par- 
oxysm. This point will bear further investigation. I am in- 
formed, however, by Dr. Meredith Clymer, that, in a recent re- 
port of English army-surgeons serving in malarious regions, 
the verdict is decidedly in favor of administering quinine (this 
does not refer to the hypodermic method) during the attack. 
As regards the dose, it depends, like that administered by 
mouth or rectum, on so many circumstances that one cannot 
be definite. But the variation, depending on idiosyncrasy 
and age especially, is not nearly so great as in the other meth- 
ods. The doses of various reporters have varied from two to 
ten grains. The fact is that, at present, it is limited some- 
what in obstinate cases by the insolubility of the drug, a dose 
of twelve or eighteen grains requiring of the solution here 
recommended two or three drachms, too large an amount of 
fluid except in desperate cases, where severe pain and ab- 
scesses are comparatively of little moment. My first doses 
were two or three grains, and the most marked results were 
obtained from these small doses, probably because the medicine 
was more largely diluted, the same quantity of fluid being 
always used; possibly a so because the disease assumed a more 
obstinate type as the epidemic wore on. For the latter rea- 
son it was found necessary to increase the dose to six grains, 
and in a few cases to nine or ten grains. When more than 
six grains were employed, I usually made three injections, but 
11 have long been in the habit of injecting morphine gr. ■§■ in the par- 
oxysm of intermittent fevers, preferably in the cold stage, to the infinite 
relief of the patient, and the arrest of the paroxysm to a considerable ex- 
tent. When the suffering is particularly severe, it is better to combine the 
morphine and quinine. I described this method in a letter to the late Prof. 
Elliot, published in the New York Medical Journal in 1870. 14 
TREATMENT OF INTERMITTENT FEVER BY 
sometimes used a syringe of greater capacity, and only in- 
serted twice. When the patient has a good deal of adipose 
tissue, and is not particularly intolerant of the injections, 
forty minims may be used in one spot. 
Repetition of Roses.—During a severe epidemic, it will 
usually be necessary to repeat the dose every fourteen or 
twenty days; in some eases every six days; and now and 
then every day or two. In these cases the patients are so 
tolerant of the injections that they care very little for them. 
Where the resulting soreness or inflammation is troublesome 
or tedious, it is better to resort, if possible, to some other 
treatment. During the intervals it will not usually be neces- 
sary to give any anti-periodic or tonic. In my own cases, de- 
siring to test the value of the treatment as accurately as pos- 
sible, I rarely gave any medicine, even of a cathartic nature, 
unless required by constipation. 
Want of time, and the fact that cases under my charge 
would often, of necessity, pass into the hands of one of my 
assistants, and vice versa, and that cases of an obstinate char- 
acter would sometimes be taken in hand by friends or nostrum- 
venders, and thus disappear, caused more or less confusion in 
my records, and have precluded as thorough and systematic 
investigation of the subject as I at first proposed. But, such 
as they are, I present my statistics to the profession, without 
waiting to attempt the solution of the various important 
questions involved, hoping that they may at least arouse more 
interest in the subject than my predecessors have done. 
My own operations number 238 on 131 patients, or 470 
insertions. Those of the other physicians, who have aided 
me in carrying out this treatment, number 151 on G3 patients, 
or 302 insertions; giving a total of 389 injections, or 778 in- 
sertions. These do not constitute all the injections of quinine 
which have been used by us during the past two years, but 
only such as have been recorded. In various ways failure to 
note injections occurred frequently, and Dr. Murdock did not 
commence regular notes of his cases until 1873. Of patients 
under eighteen years there were 29, the youngest five months; 
and it is remarkable that in no instance that I can call to 
mind has any unpleasant local or general result happened to IIYPODEEMIC INJECTION OF QUININE. 
15 
very young children—such as frequently occurred, especially 
during the first year, with adults, and with a similar solution. 
A few of the very young infants were injected a number of 
times, as vomiting was almost incessant. 
In 104 cases only one injection (two insertions) was used ; 
in 47 cases two operations; in 12 there were three; in 3 there 
were four; in 6 there were five; in 1 six; in 1 nine; in 1 
ten ; in 1 twenty ; in 1 twenty-nine / in 1 forty. 
In 9 cases it wTas noted that the hypodermic method suc- 
ceeded after failure of quinine and other remedies by the 
mouth; in 17 cases, on the other hand, that no marked effect 
was produced by the injection. In 4 of these cases, how- 
ever, less than five grains of quinine was injected, and a 
repetition of the operation might have led to a different re- 
sult, many cases requiring large and repeated doses of qui- 
nine and other remedies, and a resort to various plans of treat- 
ment as each, in turn, lost its effect. In 4 others of these 
cases failure resulted from mistaken diagnosis, the disease 
proving to be continued fever, over which the injections have 
no control. The injection thus proved to be an important 
means of diagnosis; the symptoms of the beginning of these 
irregular forms of intermittent fever being almost identical 
with those of typhoid fever. 
In 14 cases, prompt relief of the urgent symptoms, that 
is within half an hour, was experienced. In 14 cases the 
injection failed to check the disease as long as one week, and 
in these cases no further trial of the plan was made. It must 
also be borne in mind that some of the successful cases may 
have used remedies by the mouth without our knowledge, 
though care was taken to prevent, as far as possible, this 
source of confusion in the experiments. In some of Dr. Mur- 
dock’s cases he used quinine by the mouth in conjunction with 
his injections. 
In 21 cases vomiting is noted as having been so obstinate 
as to have precluded the administration of medicine by the 
mouth in any form, and generally of nourishment also. In 
every case this symptom wTas promptly relieved by the injec- 
tion. The temperature, during the paroxysm, varied from 
102° to 107°—rarely as high, however, as 106°. 16 
TREATMENT OF INTERMITTENT FEYER BY 
Iii making deductions from tliese statistics, it is necessary 
to take into account tlie fact that many of the cases, occur- 
ring during the epidemic which has prevailed so extensively 
throughout a large extent of our country for the past three 
years, have been remarkably rebellious to treatment; that is, 
the disease, though arrested with comparative ease for the 
time, has very generally recurred under any treatment;1 many 
cases requiring very large and repeated doses of quinine, and 
frequently a recourse to a variety of drugs and plans of treat- 
ment, as each in turn lost its influence; also, that in some 
cases, in which at first sight the treatment might appear to 
have been a failure, and which is noted in the above analysis 
as such (that is, as unsuccessful in arresting the disease), the 
benefit derived from it, as auxiliary to other remedies, was 
nevertheless very important: the arrest of vomiting, of severe 
cephalalgia, and other pains, sometimes the marked improve- 
ment of appetite and strength. Cases in illustration of this 
are appended. 
In two particulars, the effect of the drug administered hy- 
podermically differs essentially from its use by the mouth, 
viz., in seldom inducing severe cerebral symptoms; and in 
promptly imparting a feeling of vigor, and hopefulness seldom 
observed after the usual methods. 
To recapitulate—this method would seem, in the light of 
our present experience, to be particularly applicable to those 
fatal cases of the disease called “ pernicious ” or u congestive 
fever,” in which no reaction or a very imperfect one takes 
place, and a patient dies as in the collapse of cholera, because 
neither the stomach nor the rectum will absorb medicine even 
if they could retain it and there were time for it to act: to 
cases where vomiting is persistent, or where intense pain or 
other distress is a prominent symptom : to quotidians, where 
the paroxysm is so protracted as to afford little time for the 
action of remedies by mouth or rectum: to patients who can- 
1 In ordinary cases of intermittent fever, such as I have met with in this 
locality for the past twenty years—that is, previous to this remarkablo 
epidemic, which has invaded regions heretofore considered proof against 
malaria—I have no doubt the success of the hypodermic treatment would 
have equaled if not exceeded that of the reporters already quoted. HYPODERMIC INJECTION OF QUININE. 
17 
not tolerate quinine on account of cerebral symptoms: to tlie 
cases of the poor, and of laboring-men where promptness in 
action and cheapness of material are important considera- 
tions. Indeed, in an economic view, especially in the case of 
armies, of hospitals, and eleemosynary institutions, its advan- 
tage is very manifest, particularly in regions where the doses 
by the mouth need to be enormous; and from all parts of the 
world, temperate climates as well as tropical, where malaria 
prevails at all, we have reports of the necessity of these ex- 
treme doses in certain cases of epidemics—the doses varying 
from a scruple and a drachm, several times a day, to three 
drachms.1 I quote the following, in illustration of this, from 
a letter just received from Dr. J. C. Young, resident physician 
of Bellevue Hospital, giving the experience of Dr. A. W. 
Woodhull, surgeon to the Ninth New York Volunteers, dur- 
ing the last three years of our civil war : 
“ The greater part of his experience was gained in the 
swamps of North Carolina, at Newport News, and around 
the city of Norfolk. He met the maximum number of cases 
at the first-named place, where, in addition to the malarious 
influences so rife there, the troops were subjected to some pri- 
vations, and were, for a portion of the time, partially submerged 
in water. He saw upward of two thousand cases a year, a 
tolerably fair proportion of which had a tendency to assume 
the pernicious type. He himself suffered from the congestive 
chills. The first he did not recognize, and obtained relief by 
emesis. The congestion was pulmonary, and his face and ex- 
tremities became livid, almost black. The second was re- 
lieved by a drachm of quinine, taken in two doses at an 
interval of five minutes. In other cases, he used 200 grains, 
and in some few 240 grains (the maximum) within twenty- 
four hours. The largest dose was, however, one drachm. 
1 Socin, Professor of Surgery in Basle, states (London Practic., Decem- 
ber No., p. 424) that, in the severe septicsemic-wound fevers, during the 
Franco-German War, he employed quinine in the daily quantity of 6.7 
grammes (90 to 105 grs.). “ Under this treatment he saw many unexpected 
recoveries.” lie states also that the cinchonism was moderated by a 
considerable quantity of wine which he gave at the same time. No phy- 
sician in Europe is more trustworthy than this able man. 18 
TREATMENT OF INTERMITTENT FEVER BY 
He usually gave half-drachm doses at intervals of an hour or 
two—repeated until marked cinclionism was produced. He 
reports hut few deaths, even when the patient suffered from 
the congestive variety ; and, in the fatal cases, death usually 
ensued from the inability of the patient to retain the large 
amount of quinine necessary to produce cinclionism.” 
I have selected the following typical cases, very briefly re- 
ported, as likely to be of interest to the profession, and in il- 
lustration of the preceding remarks and statistics : 
Cases in which very Small Doses were successfully used. 
Case I.—Robert McC., aged forty years; general health 
good. Quotidian four days, coming on in afternoon, lasting 
until morning. His sufferings intense, especially the cepha- 
lalgia ; and his vomiting for some hours uncontrollable. Has 
taken repeated doses of chinoidine, but could retain very little. 
Injected in the thigh four grains in one drachm of fluid. 
Is ext day, July lltli, much better. Repeat. 
July Hlth.—Patient remained quite well until August 2d, 
when, after riding twenty-seven miles in a hot sun, and being 
much overcome by heat and fatigue, he had a recurrence. lie 
continued to have attacks at intervals, broken up temporarily 
by various methods, the injections having caused a trouble- 
some abscess. 
Case II.—P., aged fifteen years. Has had fever all spring 
and summer, broken repeatedly by quinine and chinoidine, 
but sometimes recurring even while taking the medicine. 
August 10, 1872.—Injected half a drachm (2 grs.). 
11th.—Feels pretty well, and is at his work. Repeat. 
Hist.—Has remained well. Fever subsequently recurred, 
as I heard. 
Case III.—Mrs. McC., aged sixty-three years. In bad 
health for twenty-five years. Has suffered, more or less, all 
summer from irregular intermittent. Has taken quinine and 
chinoidine, but she is more or less under the influence of ma- 
laria all the time. Injected to-day, August 12th, one drachm 
(2 grs.). 
August 20th.—Continues quite free from any manifesta- 
tions. HYPODERMIC INJECTION OE QUININE. 
19 
28th.—Has been in better health since injection than she 
had been for six months. Had no recurrence. 
Case IY.—Mrs. M. R., aged sixty years ; a feeble woman, 
always complaining of some ailment, and subject to attacks 
of uterine and nephritic disease. Has been having repeated 
attacks of quotidian. Has now dysentery (probably malari- 
ous), and is vomiting incessantly; can retain no medicine and 
is much reduced. Temperature 105°. Injected one drachm 
(4 grs.). 
August 20th.—Has been pretty well; no symptoms of 
fever. Has taken no medicine. Some deafness remains. 
September 8th.—Continues well. 
Case Y.—Mr. NY, a stout, healthy farmer, aged thirty-six 
years. Has had several attacks of fever, and has broken it by 
quinine, chinoidine, and nostrums. But the present attack 
(quotidian) is attended by unusual symptoms—violent abdom- 
inal and crural cramps, vomiting incessantly, great debility, 
cephalalgia, etc. Gave him yesterday an anti-emetic mix- 
ture and chinoidine pills ; but they were rejected. His tem- 
perature was 106°. Had his chill to-day two hours ago. Tem- 
perature now 105°. Injected quinine solution 3 j (3 grs.). 
August 11th.—Second day. Has passed over the time for 
attack two hours. Temperature 100°, skin pleasant, pulse 
feeble. Injected two grains. 
20th—Ho fever since last date. Injected two grains. 
21^.—Feels “ more like himself,” as he says; able to work 
a little. Subsequently had another moderate attack. 
Case YI.—NY, aged fifteen years, a stout, healthy lad, pre- 
vious to his attacks of malaria, which have reduced him very 
much, notwithstanding a systematic course of quinine and 
chinoidine. Injected to-day, August 19th, half a drachm of 
solution (2J grs.). 
August 21 st.—Is still very weak in his limbs; no fever. 
Injected one drachm (4 grs.). 
24th.—Feels “ a great deal stronger,” and better than he 
has been for a month. Injected one drachm (4 grs.). 
September oth.—Well. 
Case YII.—Mrs. W. AY., aged forty-five years; a thin and 
feeble-looking woman always, but almost reduced to a skele- 20 
TREATMENT OF INTERMITTENT FEVER BY 
ton now by long-continued attacks of malarious fever (two 
years). Has never succeeded in breaking it up for more than 
eleven days. Comes from Hew Jersey. Quinine lias sucb an 
unpleasant effect on her that her physician told her she “ must 
never take it again.” Injected quinine two grains. The im- 
mediate effect was “ faintness,” and, within fifteen minutes, 
dizziness and excessive weakness, which marked the effect 
of the drug by the mouth. She could not walk without as- 
sistance, and laid on a sofa with the head low, and a stimu- 
lant given. She made one or two attempts to vomit, but the 
disposition soon passed off; her surface was cold and clammy. 
Pulse not materially affected. She left the place the next 
day, and I heard from her some months after, as having con- 
tinued free from fever, and gaining constantly in strength. 
Case YIII.—Mrs. M. Has been living on the other side 
of the Hudson Biver, several miles below. Has had intermit- 
tent for two summers. Broke it up last summer by a nos- 
trum, but failed this summer. Chill is now due in four hours 
(quotidian). She applies, not for this trouble, but for the re- 
moval of her tonsils. Performed this operation, and then in- 
jected four grains of quinine. 
September 26th.—Patient writes that she has had no return 
of fever. 
October 7th.—Had no return of fever until yesterday. 
Cases in which Immediate Relief of Distressing Symptoms 
was obtained. 
Case I.—M. L., aged seven years. Has had mild attacks 
during almost the wdiole summer; easily broken up by qui- 
nine, in full doses. Has also taken the drug pretty regularly in 
prophylactic doses. But the attacks recur. Has one now 
(August 29tli). Injected 12 minims of strong solution, 2 grains. 
September 6th.—Has continued well. 
15th.—Continued well until to-day, and was attacked with 
headache, nausea, etc. Injected 4 grains. Was relieved in 
fifteen minutes; fell asleep, and awakened entirely free from 
symptoms. 
Case II.—E. D., aged twenty-three; a stout, healthy girl. 
First attack two days ago. 21 
IIYPODEEMIC INJECTION OF QUININE. 
August 29th.—lias chill on her now. Temperature 
Inject 4 grains. 
30th.—Quite well to-day. 
September 6th.—Has continued well until this morning. 
Has a chill. Inject quinine, 12 grains. In a few hours, the 
paroxysm having been cut short, she was able to resume her 
work. Feels only a little weak. 
Case III.—Sarah G., aged eleven years. 
August 29th.—Has had quotidian for four days. Has been 
taking chinoidine regularly. But it has had no effect. The 
attack to-day is earlier and more severe. She is now shaking 
violently, and has a racking headache. Inject 4 grains. Within 
five minutes, the shivering ceased, and very soon the headache 
almost ceased. 
30th.—Feels bright and well to-day. 
Case IY.—Mrs. T., aged forty ; a stout, healthy woman, 
called me on August 30th, while in a violent paroxysm of ague. 
Intense headache, pain and soreness in abdomen and dorsal 
region of spine, also vomiting; has been suffering, more or 
less, for twelve hours. Has scarcely had any sleep for a week. 
Inject quinine, 8f- grains. 
September 6th.—Fell asleep immediately after the injec- 
tion, and slept eight hours. Has felt a great deal better; able 
to work, but weak. 
13th.—Had a chill yesterday, and two to-day. Inject 5 
grains. 
16 th.—Felt relieved in less than an hour after the injec- 
tion, and has been well since. 
22d.—Has had no recurrence. 
Case Y. McCue, aged eight years. Has been suf- 
fering almost incessantly, for some weeks, from intermittent, 
which has now assumed the quotidian type. He vomits so 
constantly now that he can take neither food nor medicine, 
and is much reduced. Inject 4£ grains. Felt better almost 
immediately, and in a few hours commenced eating, and re- 
tained his food. 
Case YL—Mrs. C. 
June 3d.—Irregular quotidian, with intense headache. Has 
had a variety of anti-periodic treatment, with little effect. In- 
ject quinine, grs. vj. 22 
TREATMENT OF INTERMITTENT FEVER BY 
28th.—Has had no paroxysm since last date, "but has been 
on anti-periodics as a precaution. Is now under Hr. Murdock’s 
charge for severe ophthalmia (iritis and corneitis), intense 
headache, and nausea. Has had hypodermics of atropine 
and morphine, but they make her “ wild.” Injected quinine, 
grs. vj. 
29th.—Headache was promptly relieved, and she is much 
better to-day in every respect. The ophthalmia subsided rap- 
idly. 
' Case YII.—Mrs. J. T. 
September 20th.—Sick for three days. Quotidian. Con- 
tinual nausea, intense right supraorbital pain. Injected qui- 
nine, gr. vj. Pain was almost entirely relieved before the inser- 
tion of the second syringeful. 
21 st.—Better, and about the house. Slept well all night. 
Ho fever, no headache. 
Case VIII.—Mrs. M. T. 
September 22d.—Tertian. In a violent paroxysm of fever 
now. Temperature 105°. Suffers especially from an intolera- 
ble “ load or oppression ” in epigastrium. Insists on an emetic. 
Injected quinine, grs. vj. Epigastric distress relieved before 
the first syringeful was completed, very much to the surprise 
and delight of both patient and doctor. 
30th.—Quite well since. 
Case IX.—M. K., aged sixty-two years. 
September 26th.—Feeble and asthmatic. Has been very ill 
for some time, with quotidian; the symptoms severe and 
almost continuous, reducing his strength very much. Ho sleep 
for several nights. Inject solution Magend., gr. xv, and to take 
quinine pills. 
26^A.—Slept well; but, as he could not retain the quinine, 
has had a severe chill to-day. Pulse frequent, and very feeble. 
Intense headache, semi-conscious. Inject quinine, grs. vj. 
28th.—Went to sleep about an hour and a half after the 
injection, and slept well. Feels a great deal better, except the 
debility. 
Case X.—Mrs. L. P. 
October 19th.—Suffering from quotidian for some days; 
the symptoms almost continuous. Has fever now, attended 
by violent “cramp ” in the epigastrium. Inject grs. vj. HYPODERMIC INJECTION OF QUININE. 
23 
21st.—Says the cramp was relieved in fifteen minutes. 
Feels the pain returning in the stomach. Repeat injection, 
which again relieved the symptom in ten minutes. 
21th.—Uo trouble since last date. 
Case XI.—Mary C., aged twenty-one. 
November 1st.—Has had repeated attacks during summer. 
Has lately been taking twenty-seven grains of quinine daily, 
with no effect. Suffering now from most intense frontal head- 
ache. Inject grs. ix. Head-symptoms mitigated before the 
completion of the operation. 
2d.—Slight cinclionism, but feels relieved of all painful 
symptoms. 
Case XII. Anderson. 
September 10th.—A feeble old man, suffering for' some 
weeks from quotidian, and has been on quinine pretty regu- 
larly, with but little effect. Headache and nausea continu- 
ous ; debility rather alarming. Injected quinine, grs. vj. 17a? 
almost immediately benefited. 
20th.—Much better. Up and dressed, and eating, with a 
fair appetite. 
Other cases, precisely similar to the above, might be 
quoted ; but they are still very exceptional; and, in most of 
these cases, the disease recurred after a longer or shorter inter- 
val, and were again injected, or had other treatment. 
Some cases of malarious cephalic neuralgia were promptly 
relieved, like the following: 
Case I.—A. H., aged fifty. 
December 5th.—Had supraorbital neuralgia about four 
weeks since, and was relieved by an hypodermic injection of 
morph, et atropia, administered by Dr. Murdock. Since then, 
has had a regular paroxysm of febrile intermittent, and the neu- 
ralgia has recurred, and is periodical. Injected quinine, grs. 
viij. 
December 31st.—Has had no return at all. 
Case II.—Mrs. T. B. 
September 5th.—Has been troubled with malarious mani- 
festations for eight months, previous to and after her confine- 
ment, these being confined mostly to cephalic pain and debil- 
ity, never any regular paroxysm. They resisted all ordinary 24 
TREATMENT OF INTERMITTENT FEVER BY 
anti-neuralgic remedies, and only yielded to large doses of 
quinine. Has been kept most of the time, since the attack 
was broken up, on quinine or chinoidine; for some time, has 
complained of a pain at the vertex, which has become severe 
and continuous, but worse at certain hours of the day. Six 
grains of quinine every night has kept it under somewhat, 
but does not remove it. Has also been on pills of iron, qui- 
nine, and strychnine, with no very good effect. To-day, in- 
jected quinine, gr. vj. 
September 9th.—The headache has almost entirely sub- 
sided. 
January 9th.—lias continued well, until about ten days 
since. Has now the same symptoms, but less severe. Inject 
5 grains. 
February ls£.—Ho pain since. Has taken no medicine 
since first injection. 
In the following cases an unusual number of quinine injec- 
tions were used, and vomiting occurred, also a most trouble- 
some complication:1 
Case I.—Mrs. J. W., aged thirty-two. This patient has 
been more or less an invalid for a number of years, suffering 
from uterine disease, aggravated anteflexion, and endome- 
tritis. Tour or five years ago, while pregnant, was attacked 
by low fever, of a remittent type, which could only be arrested 
for a time by quinine; finally, vomiting set in, and she was 
reduced to such a state of emaciation that the propriety of the 
induction of labor was discussed, but she pulled through. In 
1 Since this paper was written, I have received the January number of 
the American Journal of Medical Science, in which I find an article by 
Dr. George A. Musick, from which I quote the following: “ For several days 
my patient’s life‘hung by a thread,’ the stomach rejecting everything; 
but, by this method (hypodermic) it (quinine) was administered with facil- 
ity, and its action was prompt. To it and the administration of sufficient 
nutriment by the rectum during the days of excessive gastric irritability, 
I believe my patient owes her life, more than to any thing else. 
“I have given quinia by the rectum, both in septicaemia and in pyaemia, 
during my military service, but its absorption into the system was so slow 
that little if any good was accomplished by it. Had I given it at those 
times by hypodermic injection, I have no doubt that my success would have 
been greater.” HYPODERMIC INJECTION OF QUININE. 
25 
1870, earlier in her pregnancy, she was threatened in the same 
manner, and Dr. Murdock, warned by former experience in her 
case, after consultation, brought on labor, and relieved her. Ear- 
ly in January, 1872, she again became pregnant, while suffering 
from malarious symptoms, and very soon uterine contractions, 
attended by pretty sharp pain, commenced ; and, as her stom- 
ach would retain no medicine, hypodermic injections of mor- 
phine were resorted to. She was under the charge of Dr. 
Murdock ; and we determined, in view of the chance of the 
anteflexion being corrected thereby, to carry her entirely 
through her allotted time, if possible. As the contractions 
commenced the moment she was entirely free from the influ 
ence of morphine, the anodyne injections were necessary to the 
end of the nine months, when a healthy child was delivered 
by the doctor, who proposes to give this interesting case in de- 
tail. Of these injections she had over three hundred during 
her pregnancy. At the same time, as it was impossible to give 
quinine by the mouth, and of the utmost importance that the 
malarious paroxysms should be prevented, it was found neces- 
sary to resort to the hypodermic injection of quinine ; and one 
containing six grains was given every six days throughout her 
pregnancy, except an accidental omission, which was followed 
by an attack, which prostrated her very much. She took, in 
all, forty of these injections, or eighty insertions. The inser- 
tions were all in the arms and thighs, and none of them were 
followed by the slightest local trouble. 
Case II.—Mrs. L. This is a still more interesting case, 
which has been under the charge of Dr. Murdock and myself 
for four or five years; and, if it ever ends, Dr. M., who has 
had the onus of the case on his shoulders, purposes to give the 
details to the profession. Suffice it to say that, for the same 
reasons which influenced us in Case I., we were compelled to 
resort to hypodermics of morphine and quinine for several 
months, and are still going on with the latter; and, as her 
uterine trouble, from which her other ailments have sprung, 
was a fibrous tumor, intramural, of considerable hulk, and 
not accessible to surgery, it was determined, after we had 
failed with other methods, to try ergot, and the hypodermic 
method was adopted; so that, for the past year, or from De- 26 
TREATMENT OF INTERMITTENT FEVER BY 
cember 28, 1872, to November 30, 1873, she has had 167 in- 
jections of Squibb’s fluid extract of ergot, or over 6 ounces and 
a half. From July 21st to the present time, January 21, 
1874, she has had an hypodermic dose of quinine, averaging 
7 grains every six days; 29 injections, over 60 insertions, or 
203 grains of quinine. For six months prior to September 1, 
1872, she also required an hypodermic of morphine, combined 
always wTith atropine, our invariable custom now, daily; so 
that she has had, during a portion of the year, 182 injections 
of morphine and atropine, 167 of ergot, or 334 insertions of 
ergot, and 29 injections, or 60 insertions of quinine—a total of 
576 syringefuls of the four drugs, and in only one instance after 
an injection of ergot, made by myself, did any considerable lo- 
cal trouble result, an abscess of the thigh—although the patient 
was in a most miserable condition of health all the time, kept 
alive for months on small portions of pulverized raw meat, 
champagne, brandy, and sometimes biscotine. A delay of a 
day or two in the quinine injection is sure to be followed by a 
severe paroxysm of intermittent, and now and then even 
within the six days. I will anticipate the further publication 
ot the case by stating that the tumor has diminished at least 
two-thirds, and that the patient’s condition now is better than 
it has been for a year, and she is steadily improving, all haem- 
orrhages, which were extremely difficult to control, having 
ceased long since. 
Case III.—This patient, a feeble woman, aged about thirty 
years, was confined October 27, 1873, attended by I)r. Far- 
rington, one of the resident physicians of Bellevue Hospital, 
who reported that she flooded both before and after confine- 
ment. Thepost-partum haemorrhage was promptly arrested, 
but she lost a sufficient quantity of blood to reduce her very 
greatly; and, as she had suffered for a long time from mala- 
ria, she subsequently became extremely anaemic. She was 
convalescing very slowly when mammary inflammation set in, 
abscesses formed, and simultaneously she was attacked by her 
old enemy malarious fever, and she was alarmingly reduced, 
the vomiting being extremely persistent. Neither medicine 
nor food could be retained on the stomach, nor could she bear 
enemata, on account of diarrhoea. Under the circumstances, Dr. HYPODERMIC INJECTION OF QUININE. 
27 
Murdock, who succeeded Dr. Farrington in the management 
of the case, resorted to hypodermic injections of quinine, 
which were commenced on December 6th, and continued 
either every day, or alternate days, until January 9, 1874, at 
which date she had had twenty injections, or forty insertions, 
averaging seven grains at each injection. The injections kept 
the disease at bay until December 25th, when she had a chill; 
since which date the nausea and vomiting, as well as the diar- 
rhoea, having been promptly arrested by electricity, from six 
to twenty-four grains of quinine have been administered daily 
by the mouth in addition to that contained in the injections, 
as the case was so desperate that it was considered proper to 
saturate the system as freely as she could bear. 
Notwithstanding this, so firm a hold did the malaria have 
on her system, that she had a return of the fever on December 
30th, since which no manifestation has appeared, and she is 
improving daily. No local trouble has resulted from the in- 
jections, nor have they annoyed her enough to produce any 
complaint. 
It has happened not unfrequently that a severe malarious 
attack immediately preceded, or coincided with, or succeeded 
parturition. In these cases the hypodermic injection had a 
particularly gratifying effect. I cite one case only in illustra- 
tion of this class, as this paper has already become much 
more extended than was anticipated. 
Case reported by Dr. G. W. Murdock.—Mrs. I. M., thir- 
ty-eight; confined by Dr. M., December 26th. Forceps at 
superior strait; every thing proceeded favorably till the 28th, 
just forty-eight hours after delivery, when she was attacked 
by a severe chill, attended by intense pain in head, back of 
neck, dorsal region, and abdomen; lochial discharge arrested; 
no mammary secretion ; uterus enlarged and very tender; tem- 
perature, 105°; pulse, 130. Injected quinine, grs. viij.; morph., 
gr. at 10 a. m. At 10 p. m., patient more comfortable. 
Temperature, 103°; pulse, 100. Injected quinine, gr. iv.; 
morph., gr. 
December 2i9th.—No fever; lochia reestablished; milk ap- 
pearing in breasts; temperature normal. 
30^.—Doing well. Medical Works published by D. Appleton & Co. 
Anstie on Neuralgia. 1 vol., 12mo. Cloth, $3.50. 
Barker on Sea-Sickness. 1 vol., 16mo. Cloth, 75 cents. 
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