Internally. - Undoubtedly the principal use of quinine is in the treatment of malarial diseases. When we realize that quinine in 1 part to 20,000 is sometimes destructive of the plasmodium mala-riae, it is readily understood why the drug should be so efficient as an antimalarial remedy.

Quinine is one of the most powerful antiperiodics, being of more or less value in many diseased conditions characterized by periodical exacerbations. All forms of malarial fever usually yield to the proper use of quinine. It seems to be somewhat efficient as a prophylactic.

From a practical point of view it is fairly well established that at certain phases of development the malarial parasite offers less resistance to the action of quinine than at others. Thus, in the early stages of the parasite's development, particularly while in the blood cell, the resistance to quinine is very marked; parasitic forms, which are free, swimming in the blood-serum, offer less resistance. The best results are obtained from quinine when administered during the stage of fever or in the period immediately preceding. Early doses of quinine check the development of the second stage, and prevent, in part at least, the segmentation of the parasite. The practical point to be gained from the recent studies is that quinine given in the period preceding the fever and during fever is most effective in the cure of the non-pernicious types of the disease. As it take from two to four hours for quinine to saturate the plasma, this amount of time should be allowed and a dose of from 10 to 15 grains, given two to three hours before the chill which is thought to record the breaking free of the parasites from the red blood-cells.

Many periodical affections due occasionally to malarial organisms are peculiarly amenable to this drug, among these disorders being various neuralgias, headache, asthma, hay fever, chorea, jaundice, diarrhea, dysentery, etc.

It is particularly beneficial in cases of prolonged suppuration, such as pulmonary phthisis, fistulous discharges, septicemia, pyemia, puerperal fever, etc. It favorably influences the formative stages of acute inflammations, as in the beginning of endocarditis, pneumonia, pleurisy, etc.

As a tonic or restorative during the course of febrile diseases, as well as in convalescence, quinine is highly efficient. Its action upon the gastro-intestinal tract renders it valuable in many forms of dyspepsia, especially the atonic variety. In these cases, where anemia is present, the drug may be advantageously combined with iron and nux vomica.

Quinine is but little used now as a pure antipyretic. Its antipyretic influence is consequently more marked in intermittent fever. It is of value also in typhoid, but less as an antipyretic than as a general tonic.

It is of decided value in the yeasty vomiting produced by the sarcina ventriculi, and equally beneficial in impetigo; while acne and ecthyma, when occasioned by reduced vitality and impaired nutrition, are greatly benefited by its internal use.

Quinine is serviceable in stimulating the uterine contractions during labor and increasing the menstrual discharge in amenorrhea.

Contraindications. - The drug is contraindicated in acute inflammations of the genitourinary and gastro-intestinal tract, in acute or subacute inflammations of the middle ear, and in meningitis and cerebritis. It should not be given to infants suffering from eczema, nor to persons having a marked idiosyncrasy against the drug.

Administration. - Because of its intensely bitter and disagreeable taste quinine should not be given in solution. It may be suspended in syrup of yerba santa or in the aromatic elixir of licorice, which disguises the taste quite effectually, and for children is preferable, as a method of administration, to capsules or pills. In the case of adults the drug should be given in gelatin capsules or in the form of gelatin- or sugar-coated pills.

The tannate of quinine is comparatively tasteless, and may be incorporated with chocolate in the form of lozenges, thus being readily taken by children.

The drug may be also administered in a suppository by the rectum or incorporated in lard and rubbed into the skin, preferably in the axillae and the inner side of the thighs or over the abdomen. It has been employed to some extent hypodermically, the quinine hydrobromate and bisulphate being the salts preferred for this purpose. Injections should be made in the buttocks, and very slowly administered, since this method of administration depresses the heart to a considerable degree.

Occasionally in the treatment of malaria Warburg's tincture, containing quinine and numerous aromatics, is efficient.

In obstinate malarial affections aromatics and spices greatly enhance the effect of quinine, capsicum making one of the best adjuvants. The portal circulation is stimulated, rendering the absorption of the drug more rapid and its effects more lasting.

The various tinctures and elixirs of cinchona are used extensively; when employed as stomachics they should be given before meals.

Quinine is best given on an empty stomach or after the active process of digestion is completed.