be a

and burden the field with the disabled or dead. There may burden of pus, and other products of the contest, to be cleared

away.

The storm of a great battle devastates the locality where it occurs; the putrefying dead may breed a pestilence. The ravages of war are widespread. The resources of the country sustaining it are heavily taxed. It may be wiped out of existence or be no more known in the family of nations, or, if spared, may be long in recuperating its energies and repairing its wastes.

In the locality of this inflammatory battle the tissues are laid waste. The disabled and dead bodies of the contending parties are found in abundance. Bacteria are seen in different stages of destruction. The dead bodies of cells themselves become injurious. The battle-field becomes a breeding ground for more bacteria. When the battle has proceeded far, much time may be required to clear away the débris, or complete repair may be impossible. The death of the part or the whole organism may result.

This comparison may be said to be fanciful. It is so. It may be said there is a transition from sober fact into wild fiction-at least from scientific truth into speculation. But this is not the only instance in medicine where science merges into fanciful speculation, or where, upon a slender and perhaps doubtful foundation of facts, theories are erected. But speculation and theory often lead the way to substantial and important truth, and more frequently afford plausible explanations of indubitable facts.

That in inflammation a great commotion occurs, resulting when severe in more or less evil effects, we all know. In this process, that some injury is done to the part, which causes the phenomena, all are agreed. There are disturbing and apparently contending elements, and this view taken of its nature is not without plausibility.

According to this theory, whichever party is in the end vic torious, the contest itself (which is the inflammation), though often resulting in surgical cases in repair of wounds and expul

sion of foreign substances, is yet, when severe, and generally in medical cases, a great evil to be abated or subdued. Destruction or permanent impairment of the local or the whole organism is sadly frequent.

The most important question in therapeutics, indeed, in the art of medicine, is as to whether we have efficient means, and what are the best means, for controlling inflammation? Have we measures for destroying or expelling the intruding enemies or the irritating agents? A thorn in the flesh, or other gross foreign body, can often be extracted mechanically. A well known chemical irritant can often be neutralized by its antidote. Some specific poisons can be successfully expelled, overcome, or at least modified, in their actions. Others are obscure, concealed or unknown, or not to be safely reached by any means within our knowledge. In the battle we have supposed to exist, the destruction or expulsion of the enemy would end the contest, and, if early enough, repairs would soon be made.

But we cannot reach all microbes; we still know too little about "ptomaines" and "leucomaines" to combat them with intelligent precision, though there is the greatest reason to believe they act an important part in the production of many morbid states, and we are not sufficiently far advanced in the methods of successfully dealing with all the specific poisons.

When the enemy cannot be summarily expelled, have we any means of quieting the intensity of the raging battle, or commanding the fierce contest to cease? Are there any agents that can call a truce, or say with a potent voice, "let us have peace?" What is our knowledge on this subject, and how are we to obtain more?

A full answer to these questions, were it possible for me to make it, would require such time and labor as a waning life would scarcely afford. The present occasion will allow of only a few brief suggestions.

Experimental investigations in the laboratory upon animals, and observing the effects of different agents upon the healthy

human system, may throw great light upon various pathological and therapeutical questions; have indeed settled some of them, have suggested the use of various medicines in controlling disease, and have explained the known action of many others. But the test of all knowledge of curative processes is in clinical therapeutics-in observations at the bedside-in witnessing effects upon the actual states of disease. Here I am aware that appearances are often deceptive, and conclusions fallacious; but clinical observations, aided by experimental investigations and accompanied with philosophical reasoning and practical insight, are the best means we have in arriving at the truth.

Emphatically, from simple observation, we know that quinine, used in certain ways, possesses wonderful power in controlling the ague and the whole class of diseases we call malarial. The reason of such curative action, from simple bedside observation, cannot be told. Indeed, the method of its operation, after all the investigations to the present time, is still not fully known. But if it should be demonstrated that malarial diseases are produced by a particular cryptogamic germ-the bacillus malaria of Tommasi and Klebs-or any other similar organism, and that quinine destroys that organism, we should have a rational clue to the mode of its operation, at least in part, and our knowledge would become more philosophical and scientific, if not more positive.

We know also, by simple observation, that morphine, when applied to a part or introduced into the system, soothes irritation, allays pain, and generally produces sleep. We do not now, and never may know why or how such effect is produced. But both quinine and morphine produce other effects upon other and more complicated conditions and diseases, all of which we learn by careful and repeated observations.

From such observations, independent of any pathological knowledge or conjecture, of any reasoning or theories, I am prepared to express the belief, so confident in my mind, that it amounts with me to satisfactory knowledge, that quinine in suf

ficient quantity, especially when combined with appropriate doses of morphine, given in the early stage of most acute inflammations, exerts upon the processes a wonderfully controlling influence. It often says to the supposed parties in this battle, "let us have peace." Whether the peace is conquered by subduing, expelling, or destroying the intruding enemy, or by soothing the parties and commanding a truce, or whether the remedies protect the field of battle from the usual ravages inflicted, I do not know. Whether the greater action of these agents is upon the irritant, upon the cells of the tissues concerned, upon the active moving cells or leucocytes, upon the nerves and vessels of the part, or upon the central nervous system, or in two or more of these ways, or, in fact, in some other way, are at present matters of conjecture. But the fact that under this treatment the inflammatory process is generally checked or arrested, is a matter of observation and knowledge.

I do not say that this treatment is always successful (we, perhaps, have no positive specifics in medicine), or that it is the best treatment in all cases; but I do say that quinine and morphine, properly used-boldly, yet cautiously-will exert what seems to me a wonderful influence over the early stages of most acute internal inflammations.

No absolute rule can be laid down as to doses and times of administration. These will vary in different cases, according to the locality and character of the inflammation, and the susceptibility of the patient. The quinine is less applicable to inflammations of the stomach than to those of other parts, and neither is as well adapted to inflammations of the brain as are some other remedies. But in pneumonia, pleurisy, peritonitis, metritis, tonsilitis, etc., free doses are well borne and are efficient.

From five to fifteen grains of quinine, with from one-sixth to one-third of a grain of morphine, are the quantities usually proper for the first dose, and subsequent doses, repeated once in from two to four hours, should be sufficiently large to keep up a relaxing, diaphoretic, antipyretic and anodyne effect. The morphine

may be continued or omitted, given in each or every second dose, according to the effect, or the condition of irritation or suffering, or of sopor present; but the quinine should be continued until from a scruple to a drachm has been given, and the inflammatory symptoms are allayed.

The quinine should then be suspended. Its continuance in large doses longer than twenty-four or thirty-six hours is not only unnecessary, but may be injurious. The brain may be seriously disturbed by its protracted action in these larger doses. A single alcoholic fit of intoxication may be soon recovered from, leaving only an inclination to its repetition, while a series of protracted debauches is liable to result in delirium tremens. Quinine, in free doses, may be well borne for a day or two, but, if longer continued, may produce mischief.

The administration of these doses may be preceded by an eliminative cathartic, if the secretions are already much perverted, or if the inflammation and fever have continued long enough to load the system with effete matters, the results of retrograde metamorphosis. But, if the doses are not preceded, they should be followed, by eliminatives-most important by cathartics, and often by diuretics, cholagogues and diaphoretics.

There are other medicines which operate in a somewhat similar manner to quinine, notably, salicylate of soda, and this article is even better adapted to rheumatic inflammation; and jaborandi, in doses sufficient to produce free diaphoresis and salivation, will often promptly check an incipient and even developed inflammation. Venesection in full blooded patients, and in various congestive conditions, and various other remedies, will aid in controlling inflammations, or in conducting patients through where the inflammation runs its course; but the object of this paper is to call attention to quinine and morphine as anti-inflammatory agents, especially to their power of arresting this process in its early stages.

This method of treatment has for years been my teaching and practice. Many of my former pupils are pursuing it in the dif