Vol. 60, 1909 - University of North Carolina at Chapel Hill

41
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THE CHARLOTTE MEDICAL JOURNAL
iiig, while exuberant granulations rose Quinine in Malaria.
round the opeiiings. In the granulations in Folia Therapeutica. Ziemann treats
were embedded little, white, miliary bodies, of the mode of employment of quinine in
vSmears from the pus showed, when treated malaria; of the numerous quinine preparawith
largin, very fine bacilli, having a clear tjons six have gained commendation: the
central space and colored extremities, while pure alkaloid, quinine hydrochloride, quithe
grains were constituted of the same nij,e carbamide dichloride (quinine and
bacilli agglutinated into rosettes. No thread urea hydrochloride), quinine bisulphate,
forms or clubs were observed in the smears, quinine tannate, and the synthetic equinine
but the grains were composed at the peri- (ethylcarbonic ester of quinine). All these
phery of clubs, and in the centre of very ^ust be introduced into the stomach in an
fine threads or minute bacilli. This organ- easily soluble form which guarantees the
ism proved to be a discomyces, related to quickest absorption.
that of actinomycosis, and to it the authors 'fhe best way is to take the dose of quidesire
to attach the name of Discomyces nine in water, to which has been added five
Thibiergi. In the light of these and other or ten drops of hydrochloric acid. Huquiresearches,
one ought, therefore, to speak nine has the least unpleasant tasle, the
now, not of actinomycosis, but of actinomy- others causing repugnance. This may be
coses. The most various parasites appear avoided by swallowing the tablet or encloscapable
of giving rise to actinomycotic ing the salt in gelatin capsules, with chocoforms.
In the case in qi'estion, under full late, or with wafer paper,
doses of iodide internally, supplemented by Quinine is better tolerated if given durincisions
and erasions locally, the existing ing^the nonfebrile period. In dealing with
lesions healed, though somewhat slowly, pernicious malaria, however, we cannot
and the commencing ones aborted without ^ait for this, and in fact there may not be
suppurating.—Edinburgh Medical Journal, any apyrexial period whatsoever.' Nocht
The Presence ol Sudanopliile Leuco- recommends that the dose of one gram
cyics in Diplitlieritic Inlection. should be divided into five parts and ad-
Luigi Benini describes the results of blood ministered at intervals during the day.
examination in diphtheria. There is an in- Ziemann prefers in recent pernicious
creaseofleucocvtosis which intensifies with types, to inject the drug hypodermically,
the severity of the infection. The use of and for this reason selects the most soluble
antitoxin produces hypoleucocvtosis after preparation of quinine, the carbamidated
a half hour from the injection, followed by dihydrochloride (soluble in 50 percent,
hyperleucocytosis lasting for twenty-four water, and containing 70 per cent, quinine),
hours. The leucocytes contain granules When this is employed subcutaneously nethat
are named sudanophile, which indicate crosis of the skin at the seat of injection
an intoxicating agent circulating in the ^^Y follow. He accordingly advises that
blood and having a specific action on the it be injected intramuscularly,
bl.jod. The author has made a study of This method has been tried in thousands
these sudanophile granulations in the blood of instances and has been followed by
of patients at the Pediatric Clinic at Flor- splendid success. A Ricord syringe coneiice.
There were ten cases of severe and taining 4 centimeters and a canula is boiled
twentvnine of less severe diphtheria, and "^ a test-tube, the opening directed downnineteeu
cases of laryngitis. Experiments ward. The water is poured off, the syringe
were also made in animals. The author removed with a pair of sterile forceps and
concludes that in diphtheria there are de- the canula applied. Then a sealed glass
generative changes determined by the tox- tube containing one dram of quinine dihyiiis
of the disease, and these granulations drochloride in l.T minims of water is broken
are found in even the mononucleated leuco- at the apex and the contents sucked up by
cytes. Xo pus corpuscles are found. These the canula. Next 3 cubic centimeters of
sudanophile granules are more frequent in sterile water are ^sucked up at a temperasimple
angina than in the croup cases, ture of about 40 C. The quinine solution
They are greater in number in severer cases is then mixed by raising and depressing the
and are an indication of the severitv of the syringe, the piston is pushed in till the quidisease.
They diminish on the third dav "i"e solution begins to issue from the
of treatment and disappear as convales- canula, and the whole contents of the
ceuce is established. They are not directly syringe introduced vertically into the midinfluenced
by injections of antitoxin. In die of one of the gluteus maximus muscles,
febrile complications they reappear, but are the area of injection having been previously
not found in post-diphtheritic paralysis, disinfected. The mid- area between the tro-
They are determined by the toxic action of chanter major and the tuber ischii should
the diphtheria toxin on the leucocytes of be carefully avoided so as not to strike ihe
the blood.— Rivista di Clinica Pediatrica. sciatic nerve. Only very rarely does this