Recent Literature Clinical Manual for the Study of Medical Cases . Edited by James Finlayson, M.D. Second Edition, Revised and Enlarged. With 158 Illustrations. Philadelphia: Lea Brothers & Co. 1886
Boston Medical and Surgical Journal
said that of twenty cases of pneumonia in children, treated by him with quinine or cinchonidia, in twelve the drug was given in sufficient doses, and for a sufficient length of time, to enable him to form some opinion of its action ; and in nine it was a total failure, so far as any effect upon the temperature was produced. He gave as much as sixteen to thirty grains a day to children from one to one-and-ahalf years old ; and in two or three cases the temperature rose steadily after the quinine
... y after the quinine had been taken. His own feeling was, that as an antipyretic, quinine in small doses was useless, and in larger doses dangerous. When the fever was high much better results could be obtained from the judicious and continued use of the cold pack. By this means he had been able to .save a number of children whose cases were apparently hopeless. Unless the temperature reached a very high point, however, he was doubtful about the efficacy of antipyretic treatment in pneumonia. For the past two years he had abandoned quinine entirely in aotite pneumonia, as he had found that it almost always gave rise to vomiting and other bad results ; and since he had discontinued its use he had met with at least as good, if not better, success in his treatment. Quinine, however, was of very marked advantage in convalescence and in protracted cases of bronchopneumonia, if given in small doses. The President, Dr. A. Jacobi, said that he had seen a number of changes in professional opinion concerning quinine, since he commenced practising in New York, thirty years ago. At that time it was given in doses of half-a-grain or a grain to adults, and in smaller doses to children; and much was expected from it. It was true that a large number of cases got well; but they were the kind of cases alluded to by other speakers in which the natural tendency was to recovery. It was only in the bad cases, however, that we could judge of the real effect of a remedy. At that time, and ever since, he had been in the habit of giving six. eight, ten and twelve grains of quinine to children, and it was his practice to administer it deliberately at certain times of the day. He usually gave full doses in two installments in the morning, when the remission occurred : say five grains at eight, and five at eleven. If it did not affect the stomach unfavorably, however, he would give a single full dose in the moruing. lie thought that a good deal of the inefficiency of the remedy which had been spoken of, was due to the condition of the stomach incident to the febrile state, which prevented it from absorbing ; and thus the quinine was not digested. The same was true of the condition of the rectum. Therefore, he preferred to give it hypodermically ; and when this method was used the good effect of the drug was apparent in a short time. A reduction of temperature could thus be effected, which was impossible with quinine used in any other way. The best preparation for hypodermic injection was the carbamide, on account of its great solubility. There was no use in giving quinine if the temperature did not rise above 102 ; and it was to be borne in mind that it should by no means be given in every case of pneumonia, but only in occasional instances. In many cases, when the fever was high, antipyrine was excellent. Dr. Ripley said that in quite a large number of the cases referred to in the paper, the quinine was given by hypodermic injection ; yet the result was the same as in the other cases. The muriate in strong solution was the preparation employed. In many of the protracted cases to which reference had beeu made in the discussion, he believed that there was an associated pleurisy, and this is often a difficult thing to recognize in children. As to the use of antipyretics in general, he said that in an asylum with which he was connected, sixty cases of measles had recently occurred. A considerable number of them were treated with antipyrin, but it soon became apparent that these children did not do as well as those treated by the ordinary simple methods. Dr. Jacobi remarked that it was not safe to use too concentrated a solution of quinine for hypodermic injection, and related a case he had met, in which, at the autopsy it was found that the quinine was all deposited in the cellular tissue, the water of the solution only having been absorbed. -*-Recent L i t e r a t u r e . Clinical Manual for the Study of Medical Cases. Edited by James Finlayson, M.D. Second Edition, Revised and Enlarged. With 158 Illustrations. Philadelphia: Lea Brothers & Co. 1886. Although this book has been revised, re-written in parts and considerably enlarged, it still retains the characteristics of a genuine manual, and that is absolutely essential in a work whose aim is to " afford such assistance as students, actually working at clinical medicine, might seem to require." The volume is practically the product of the Glasgow School of Medicine. There are five contributors beside the editor ; all six contributors, with one exception, are connected with the Glasgow medical institutions. Among the contributors we find the wellknown names of Drs. W. T. Gairdner and Joseph Coats. To students of clinical medicine this book can be recommended as a convenient and suggestive one. This is the December number of " Wood's Library of Standard Medical Authors." The title-page gives a quite distinct idea of the scope and contents of the volume ; a statement which is not necessarily a truism. The division on diseases of the blood includes diseases of the blood-producing organs, meaning thereby diseases of the spleen. Diseases of nutrition are represented by obesity, gout, diabetes mellitus and insipidus, rickets, osteomalacia, and arthritis deformans. Infectious diseases are divided into (a) those with typical localization, and (b) those with variable localization, under which latter head are placed tuberculosis, syphilis, leprosy, diphtheria, and the zoönoses, namely, diseases communicated from animals to men. The question of treatment is not neglected under the different headings. The illustrations are numerous, well selected and fairly executed.