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202 INFLUENZA R EXPERIENCESMITH INFECTIOUS DISEASES
TUE secon epidemicis influeneta pandemici in October 1918.
resulted in fewe admission than the Brst Ver speciat stress must e laid o the exceedingly ood effect of the quininetreaiment Blesch an on quinine prophylaxis In no case id Iobserve serious tuns complications, whicli ere other is so frequentandrio readed i quinin hydrochloride s0.3 ram' ice or more frequently per day was sive early Those ho received by wayo prophylaxisi. gram os quinine hydrochloride every 2 to 3 daysescape the liness, or ad it in a very mil form. I also found this fac confirme after the war both in the arm and in private
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OVER DE THERAPIE DER BASEDOw-ZIENTE
UIN INE. o the ther hand is an invaluable rus, hichhardineve falle me Bram has contrived a quinine est,hichis based on the faci found by many investigator that sufferers hom thyroidis cari endure a very large amount of quinin without hein troubled by astri deransements o by inchonism tinnitus aurium and siddinessi As resard three-fourtiis os, cases I canconfirm his. ith ther patient ho euer fe in number the administration o large doses of quinin is altosether impossible the intolerance may eve hecome total with Such patients another remedymusti fought for with mos howeve the result is rilliant Paulesco reporis 2 cases and obtain q2 complete and lastin cures.
The resulis, accordin to him are based on the vaso-constrictor propertie o quinine preparations. An ansiotoni effect to hichthere is adde a cardio-toni action. Since quinine an iis Somer, quinidine have been sed intensivel as a means against Arrhythmia e frequently in cardia therapy administer digitalis alternatelYMithquinine: these senis although to a certain extent antasoniStic, mutuali strens then ea Mother.
Althouu weano aut litilem to the elementar actionis quinineone hin is certain. namely the retardation o ali vita processes. By the absorption o quinin the conversioni stycose into Susartalis ossi an a the albuminous metabolismis also limite with a reductio of the productio os urea it must e supposed that thelowerin os temperature hic is brought about in patients with in- creased bod heat laver exophthalmi solire is due maininto reduc tio of hea production. Nevertheles it cannotae dente that to a
certain extent quinin Acts directi the centra heat resulation. In an event i is an agent whicli has an excellent effect against the chies Symplom accelerate metabolism. It is no necessar to se large quantities Paulesco sives, in theeVenins during the evenins meat. 2 tota cachetsi quinine hydro-bromide hydrochloridem preferably sulphate of 0. 50 frameach, with
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intervals of V of an hour thus administering up to l. 50iram os quinine sulphate. Personali 1 sive .80iram in two portion and increaseslowl every aY As oon a tinnitu besin the patient must so tobed. Eo eight day the fame agent musti administered, the folio eight days rest, and o forti untii clear appearance of resulis retardationo pulse, disappearance Os exophthalmos and oitrein Aster his the quinine a be reduce to three day a wee unti there is complete cure. hor relapse of one or nother Symplom re com bated in the Same Hy. The durationis the quinine reaiment must dependan the first placeo the capacit of the patient to tolerate it the large the doses tolerate the more speedily the symptom disappear in the secondplacein the time hicli has expired since therilines besan the more recent the alter the more speedy the cure. Deep-rooted ophthalmicsoitre requires a term hic mill extendisve monilis Here iodine
The effectis quinin may also he strensthened by the administration twicem days of 0. 50iram os ergo secate cornutum). BIBLIOGRAPHY
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TRAIT EMEN DU SYNDRO ME DE BASEDOwὶ
Physicia in the Generat Hospital
THE author after indicatins the various potherapic rectimentS, expresses himself a follows with resar to quinine:
The ni non-opotherapi treaiment possessin an utilityi certain ell-selecte cases, is quinine. Recommende Someaears ago by Lancereaux and Paulesco, mons others, it is no aesinninsto e sed by many practitioners in iis various forms sulphate, valerianate, hydro-hromate, phytinate). Forscheimer, quote byHomata advises associatins quinine illi emotin and auo ad- vises associatins it it urea in the formis intrathyroid injections. obmineci excellent effecta stom his reaiment in Oun patienuhaolnse exophthalmisolire accompanici by sereat vaso-motor disturb- ances. The two conditionclast mentioned appea tot very important in determinins hether chemicat reaiment shouldie underinken. as has been potntediuti Freund It is interestinguo note theso ero resistance possessed by patient for his medicine hic finalty the are able to tolerate in very his doses and o weeks tosether. we a potnt ut in conclusion that this classis patienis, hoderive so much benefit from quinine and withstan it so eli, is the class hic Shows an enormous susceptibilit to adrenaline, and this clinica fac concord with the experience of Clem anci Peget onthe pharmacologica antasonismo these two elemenis, quinine and
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206 ON THE DIU RETIC ACTION OF QUIN IN EO THE DIU RETIC ACTIO OF QUIN INE
From the Pharmacologica Institute of the Medicat Facuit of the Imperia University
These clinica observations lea to the vie that quinin is to beconsidere a a histogenetic diureti a compared with the renat orcardiac diureties, such a casset an digitalis, and that iis potnt of attachus tole ound in theriissue. 2. Experimenta part O the basis of these clinica observations Linvestigatefit extrarena effect a folio s. l. In the firs placera observed the relations belween quinine diu- resis and the aikaline content of the blood in orde to clear up thequestion hether the quinine iuresis is based on drainas of thetissue in the biologica Sense or not. a. The aikaline content of the lood is uenerali found to have fallen off in drops of allainds. b. Parallel illi the quinine iuresis it raduali increases and declines again hen the drops rectRPectrS.
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c. In rabbit which had originali suffered rom anacidosis the al-kaline content of the lood re increased by injectio os quinine. d. On the ther hand in anima experiment Liaundi ne phenomenon, o to spea V the pseudoacidosis after dilution . hicli is nothased substantiali on the increas of the acid producis of metabolismin theiody.
l. The factors whicli lead to increase of the aikaline content of thebl ood in quinine diuresis are manifold Consequently it is dissiculi toattribute quinine iuresis by reasonint of this increas of the aikalinity, to drainas of the tissues, although the alter may also e involve in the diuresis. At least howeve is it to e assume fromthese experiment that quin in could promo te the mobilisationis thedischargeS. 2. hether quinin is able, physico-chemicatly to reduce the imbibin capacit of the sol in the tissue asillinger recenti assertediar ali diuretics, Pendeavoured to ascertainon his method, but ithout
q. Anima experiment illi quinine iuresis. For his purpos Iobserve the influence of quininein the capacit os absorption and excretio of the physiologica NaC solution containe in the abdomina cavit o subculaneousi injected and found that suci capacityis ver rapidinincreased in dos and rabbiis both illi administrationos quinine per os and also subculaneousi and intravenouSty. 5. Influencein the formationis lymph. a. In the normal dos by intravenous quinin injectiomnelther flow of lymph from the thoracic ducti nor diuresis increBSed. b. ut in the dos into hicli the physiological solution of NaCl hasbeen injecte into the abdomina cavlty the flow of lymplicis clearly increased In his case the diuresis is increased les than the lymph, the increas bein exceedinsi stistit, particulari on intraVenouSquinin injection. The dos o quinine sed in his case is calculated fro the clinica dose per hilogrami.002-0.0l per injectioni and
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208 ON THE DIU RETIC ACTION OF QUIN IN E
of the flow of lymph is due directi to the actionis quinine and notsecondarit to the increased activit of the kidneys. In the absorption of the scilic fluid the lymphisesset must play
great part Therefore quinin musti justis effective in the absorption of the oedemi fluid. O the other hanesit must be an important factor in absorption that the pathologica discharses are mobilised thisaein in the view of many author chiesi due to the activit of the celis of the tissue. An in m vie quinine promotes the mobilisation of the discliarses. Fina considerationS. 1. Quinine promotes the mobilisation and absorptionis the pathologica discharses in s much a the activit of the celis of the timue, the capillarnendothelia of the blood and lymphiesseis and the serous endotheliacis increased. 2. From clinica an experimental considerations quinin is to beconsidere a a histogenetic diuretic hic has it potnt of attac in
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much discussion whicli has resulted in many an varie therapeutic me ures. wis to demi a method we have used atthis lini formannyears and which, o far a P an determine, has neve falled. Sciatica may be define as asainful affectio of the sciati nerve.whether idiis a neuralsimo a neuritis is immateriat for this discussion. I has nothin to do however, it the sacro-ilia articulation, Ssom orthopedist would haveras belleve. The diseas hesin usualinas a dulliat in the lumba region or Sometimes as a typica lumbaso ut more commoni in the lowers lutea reston. Follo in this premonotor discomiar definite ains extend down the course of the sciati nerve Thesains may be borins, burnin or even lancinatin and of extreme intensity. Occasionalty the onset is rapid the initia symplomaein Sharp, hootin palnSextendinidown the nerve The ain follo accuratei the ourseo the sciati nerve The oints of greatest intensit are Suali atthe Sacro-sciati notch, in the poplitea space and occasionali do nthe calf in the line of the peronea an tibia nerves These potnis
Biso represent the areas ostreates tenderness. These ains may be continuous ut re usuali intermittent. The are osten orse atriistiti after exposure to cold. o his clinical picture may be added the classica testis extending the leuin the flexed hiuli. The stretch- in of the nerve by this manipulation increases the ain. his testis les reliable than simple palpation along the ourse of the nerVe. The scoliosis hic somelimes accompanies sciatica is indicative onlyos a severe and long-standinidiseas and may be ignored in the treat-ment when the patiis relieved the spine assumes iis normal position. Though the diasnosis is early tways asy et it is possibi tomahe a mistake Diabetes must alwaysi considered, particulari is
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the affectio is alternatin or bilaterat. Is there are definite atrophies. parctlySi or anesthesias a neurologiS Shouldie consulted. In diseases of the hi joint palima extendio n the les but is usuali notiso markedly in the line of the sciati and the potnis Sensitive to pressureare absent. Besides physica examination hows ome limitationis movemen and the ra picture ill Sho Some bon changes Asa clinica entit sacro-ilia Subluxation, particularly musti banishedas visiona , hypothetica and anatomicali impossibie. The reaimentis sciatica by injections into or bout the nerve os
drus has been advocated. Vasti more effective is quinine and urea
hydrochloride Phave advise iis se both in m book o Locat Anesthesia an in volumes of m Case Histories andri destre here
solutioni 1' . quinin and urea hydrochloride is used From fio 30 cc. are injected into an about the nerve at the potni,here illies ove the nec of the femur Thi potnt is selectediecause henthe nec of the femur is reached by the potnt of the needle the operato knows the needle has been passed deeplyaenovsh and that is thenerve has not been localed the direction of the needle must baechansed. The technic is a follows: The patient is placed o the unaffected fide wit the affected thistitials flexed. Aioint is selectedin the line belweenthe tuberosit of the ischium and the