The Lancet, 1846, vol I, page 244-5 (28 February):
ON THE VALUE OF QUININE IN AFRICAN REMITTENT FEVER.
By THOMAS R. H. THOMSON, Esq., M.R.C.S. Eng, R.N., Edin.
HAVING noticed some valuable remarks on the subject of yellow fever, by Mr. Birtwhistle, Surgeon R.N., in THE LANCET of the 3rd Jan., and in which he refers to the use of quinine in that disease, I beg to add a few statements of its efficacy as a remedy in African remittent fever, and confirmatory of Mr. Birtwhistle's observations. While acting surgeon of H.M.S. "Soudan," engaged on the Niger Expedition, in 1841-2, I had an opportunity of trying it in conjunction with chloride of mercury, in a few cases of primary fever. It certainly answered fully; but I believe it would have proved more valuable had I not restricted the quantity to two or three-grain doses.
Of its effect in the secondary and tertiary attacks of African remittent, which are certainly attended with worse-looking and more violent symptoms than the primary, it may almost be considered a specific. The first trials I made of it were at Fernando Po, in Dec. 1841, when left in charge of the sick. At that time the "Harmattan" prevailed, and although this is considered a healthy season on other parts of the West Coast, it was most decidedly the reverse at that island. All the few Europeans (old residents and well-seasoned, as far as this can be accomplished by prior attack, &c.) were laid up with remittent fever of a low character; and in all their cases I gave the quinine in doses of eight and ten grains daily, with perfect success. This induced me to try it in other cases of secondary fever, on board ship; and although in some of them the tongue was dry, foul, and cracked, with every indication of high febrile excitement, yet it had the effect of arresting the bad symptoms. Let me give you one short extract from the official journal forwarded to Sir William Burnett, Medical Director-general H.M. navy, (from the case of Mr. Anderson, entered on the sick list, April 30th, 1842.) - " May 10th. - The remissions have become very obscure; skin burning hot; occasional low delirium; rapid, jerking, but weak pulse; the bowels have been kept freely opened by seidlitz, &c. The tongue remarkably foul and dry. And both Dr. Pritchett (who also saw him at my request) and myself began to entertain unfavourable views of his recovery. I therefore determined to try the effects of quinine; and accordingly ten grains were given on the evening of the 10th.
"Continued restless during the night, but slept a little towards morning, and was relieved by a gentle perspiration. On the 11th, a very perceptible remission took place, and the quinine was again administered at noon, in an eight-grain dose. This was repeated for the three following days, when the fever gradually declined; and on the 20th, he was so far recovered, as to be discharged to partial duty, there being no other executive officer on board at the time.
"In this case, as in all the secondary attacks of remittent fever in which this remedy was tried, it produced a most marked and beneficial effect; and, strange to mention, although the tongue was in most of them foul and dry prior the administration of the quinine, it very soon became moist and clean."- (From H.M.S. Soudan's medical journal, 1841-2.)
Subsequently, in 1844, while employed in the Rio de la Plata, I was induced to try it in some slight cases of typhoid fever, in whom there existed considerable depression, a rapid pulse, and foul tongue, unaffected by purgatives; and it had the most rapid and satisfactory effect: and I think it well worthy of a fair trial in this country in typhus; but I should hesitate to use it in small doses, say two or three grains: my impression, as deduced from observations on its modus operandi, being, that in small quantity it only acts as a temporary stimulant, thereby producing more harm than good - given in a full dose, from six to ten grains, it would seem to have a different and specific action.
In all the cases in which I tried it in the African remittent, it reduced the number, but increased the momentum and roundness of the pulse. Connected with this subject, I would wish to bring under the consideration of medical officers serving on the West Coast of Africa - whether quinine in full doses has the power or not of warding off entirely the remittent fever ?
It had long been known that persons affected with any form of intermittent fever on that coast enjoyed a certain immunity from the remittent, as pointed out by the late Mr. Boyle in his work on diseases of Africa; I therefore reasoned that if quinine was known to overcome the intermittent, that remedy might be used in full doses, and produce such an effect on the system as would prevent the attack of the other and worse form of fever, which is warded off by the presence of intermittent.
On my return to the West Coast from Ascension, in 1842, I determined to commence the experiment in my own person, taking daily one or two full doses of quinine; and although I may with truth say that I was more exposed than any other person to the exciting and predisposing causes of remittent fever - being almost continually on shore and in the woods, collecting specimens of natural history, and in obtaining information about the natives at Fernando Po, Bimbia, Cameroons, &c. - I quite escaped both forms of fever. On being ordered to England, in August 1842, I considered it necessary to reduce gradually the quantum of quinine; and just before arriving home, had left it off entirely: when, strange to say, I was for the first time attacked with tertian ague in England, under which I suffered for some time; and it returned again at the same season, September, in the following year.
It must not be supposed that, in thus calling attention to the trial of quinine, I wish to advocate its indiscriminate use in all forms of fever. On the contrary, my opinion has always been, that nothing tends to bring discredit sooner on our best remedies, than attempting to place them on the footing of general specifics, or quack nostrums.
- Montague-street, Edinburgh, Jan. 1846.