the sweat, stool or urine, which differed from the crises produced by other drugs in this disease.13 A few words from Cullen's Lectures on Materia Medica, published in 1773, will show how little progress was made in the theory and practice pertaining to our subject since the time of Sydenham. We must not confuse the term antiseptic as used by Cullen with the bactericidal meaning which it conveys today. "I am very ready to allow with Dr. Pringle that a putrescency ac. companies Autumnal Intermittents, and that the Bark is noted for its anti septic quality. But the small quantity given, and still more, the very smal quantity extracted, and the little that must be absorbed of that quantity extracted, to me would seem to have very little effect in preventing the putrescency of the fluid. Much more do I imagine (and Dr. Pringle consents to it, and enumerates other Astringents which have the same property) that the Bark, in such cases, acts by restoring tone to the fibres, debilitated by the putrefaction."14 Hence its usefulness in all putrid fevers, continued or otherwise, and in "putrid Diatheses," although he considered it o greatest value when distinct remissions occurred. His practice in intermittents was to give emetics during the chill, opiates dur ing the fever and Peruvian bark with "metalic tonics" during the apyrexia. Polypharmacy was at its height at this time. The recognized fact that cinchona was a specific in malaria did not deter practitioners from mixing this medicine with other drugs. Opium and mercury were the most commonly used adjuvants to the bark, although alum, iron, antimony, cayenne pepper, chamomile, and a host of others were prescribed. Much discussion took place regarding the use of mercury. Sydenham remarked that "to add anything to the bark argues either ignorance or craft." It is perfectly obvious, however, from his writings that he did not practice what he preached, or he must have admitted himself a sinner in one or the other respect. He did not consider a preliminary mercurial purge to be always necessary for the action of cinchona. Stork, Pringle and Senac strongly advised that the viscera be well emptied by mercury in order that the humors might not be pent up by the astringency of the bark. Saunders, on the other hand, deplored any delay in the giving of cinchona, claiming that in the intermittent fevers of "low and marchy situations," "the use of either emetics or purgatives, as preparatory, is not only unnecessary, but in some cases productive of greater debility, and therefore to be avoided."4 Of all the drugs used in the seventeenth century none was more abused than mercury. It was natural that the purgative powers of calomel should have been used to rid the body of humors, but we are horrified at the enormous doses so often carried to the extent of bloody evacuations and salivation to the satisfaction of the prescriber. The ancient therapeutic measure of bleeding was still practiced on a large scale. Torti was the first to object to this procedure in intermittents, but he admitted that under certain conditions it was advisable. Every other writer of the eighteenth century gave indications for venaesection in fevers, agreeing that it was of the utmost value when the blood drawn off was "fizy." Two notable substitutes for the bark were brought forward during this period. Renaud and Homberg in France found galls of great service in agues, and explained the benefit derived as due to the astringent properties which cinchona also possessed. The Academy ordered Lemery, Geoffroy and other members to make a trial of this drug, and their report was that galls did cure intermittents, though not so constantly as the Peruvian bark.14 The other substitute was arsenic. In 1786 Fowler introduced his "mineral solution"-now known by the author's name as "Fowler's Solution," as a cure for agues and periodic headaches. He cites no less than 247 cases treated by him in private and hospital practice, giving tables of the results. His conclusion was that this medicine was as efficacious as the bark when given in 12-drop doses two or three times a day. A contemporary condemns the use of this substance with the remark that “it cannot be deemed to be a proper remedy for an intermittent fever, whilst an intermittent fever is less formidable than arsenic."3 This same author does not object to the use of mercury to the point of salivation. Cardinal de Lugo was the first to call attention to the danger of adulteration of Peruvian bark suggested by the great and sudden demand for it throughout Europe.* The first bark brought over was the red bark from the trunk of the cinchona tree. Later, however, the quill bark from the branches was introduced with success, but owing to the increased demand it was adulterated, after which it naturally became less efficacious. As we have already seen, Harvey maintained that the differences in the bark sold on the market accounted for many of the failures by physicians to cure agues. It seems that the red bark went out of fashion, and during the period that the quill bark took its place there was considerable dissatisfaction. Finally, William Saunders brought to the attention of the profession in England the fact that the red bark was that used by Sydenham, Morton and the other early pioneers who claimed such *Epistola Juan Cardinalis de Lugo al Signor Sebastiano Bado. Rome, October 4, 1659. Incorporated in the fi st chapter of the Anastasis Corticis Peruviae of Badus.la good results from it, and that in his own practice and hospital cases he had found the red bark efficacious in agues where the common bark sold on the market had been used previously in vain. Corrected in this matter of pharmaceutics, cinchona again gained favor among the physicians and we hear little more criticism of its value in malaria. REFERENCES 1a. Badus, Sebastian. Anastasis Corticis Peruviae, seu Chinae Chinae defensio. Genoa 1663, pp. 16, 22, 23, 24, 202. 2. 3. b. Idem. Cortex Peruviae Redivious, Genua. 1656, p. 35. Baker, Sir George. Observations on the late intermittent fevers; 4. Saunders, William. Observations on the Superior Efficacy of the Red Peruvian Bark, in the Cure of Fevers. London, 1783, pp. 10, 32, 42, 57 and 99. 5. Sydenham, Thomas. Latin by J. Pechey. The whole works of, 5th Ed. from the original 6. Morton, Richard. Py etologia, seu Exercitationes Universalibus Acutis. London, 1692. de Morbis p. 243. 7. Hirschel, Bernhard Geschichte der Medicin. Wien. 1862. 8. Harvey, Gideon. The Conclave of Physicians, London. 1686. Pt. I. p. 138. Pt. II, pp. 124, 126, 135, 136. 9. Torti, Francisci, Therapeutice Specialis. Mutinae, 1712. 10. Werlhof, Paul Gottlieb. Observations de Fel ribus prcacipue intermittentibus. Venice, 1764. 11. Stork, Joan. Melch. Pyretos Hemitritaios Celsi et Galeni Cortice Peruviano Curatus, in Fasciculus primus Operum minorum Medicorum et Dissertationum. Vindobonae, 1775, p. 251. 12. Pringle, John. Observations on the Diseases of the Army. London, 1765, pp. 99, 713–199. 13. Alibert, J. L.: A Treatise on Malignant Intermittents. 3rd Ed Trans. from the French by C. Caldwell. Phil. 1807. pp. 236 241, 249 and 250. 14. Cullen, William: Lectures on the Materia Medica. London, 1773. Vol. III, pp. 287 and 290. 15. Ibid: First Lines of the Practice of Physic. 3rd Ed. Edinburgh, 1781. Vol. 1, p. 67. 16. Fowler, Thomas. Medical Reports of the Effects of Arsenic in the Cure of Agues, Remitting Fevers, and Periodic Headaches. London, 1786. CLINICAL DEPARTMENT Case F. Arterio-sclerosis: - The patient is a man 64 years old. For some years he has been growing more irritable both in his business and in his domestic life. A few months ago he had a sudden weakness of his left arm and leg, which wore off after a few days. Two months ago he had diphtheria and made a good recovery. However, after this he was sleepless and more irritable and was much run down. The physical examination was as follows: General appearance Patient is a well built, developed and nourished 64-year old man; gray hair and moustache, slight alopecia; skin is white, warm, dry and of fairly good color. Patient wears a truss for a right inguinal hernia. Nose is deformed, due to previous fracture of the nasal bone. Respiratory System Breathing is regular, with a slight degree of obstruction due to the deformed nose; chest symmetrical and well developed; chest expansion fairly good; lungs show no pathological rales or fremiti. Alimentary System - Both upper and lower teeth are false; tongue slightly coated; throat negative; abdomen is distended and tympanitic. Circulatory System - Pulse 78; blood pressure, systolic 148, diastolic 95. Peripheral blood vessels are sclerosed. Heart rhythmical, slightly irregular with a pre-systolic murmur heard best in the aortic region. First cardiac sound is rather faint. Glandular and Genito-urinary Systems Negative. Extremities Dynamo-metric grip of the right hand is 80; left, 60. Feet are cold and clammy. There is a scar on the left foot from injury caused by an axe. Neurological Examination Pupils are large and react to light and accommodation readily; tongue protudes slightly to the left of the median line; face is slightly assymetrical, left side being involved. All other reflexes were found to be present and equal; no evidence of any pathological reflexes observed. Patient complains of a numbness of the entire left side, including the arm, chest, abdomen and leg, due to numbness caused from his accident. This is more severe when the patient is tired or slightly excited. The left side is more sensitive to cold than the right. On examination, however, there is no evidence of any hypesthesia.. Stereognostic sense of both sides was normal. The urine was negative, as was also the blood. The patient had baths and massage as well as a regulation of his diet. His main treatment, however, consisted of autocondensation from a Wapler coil. The important thing about blood pressure is the relation between |