Quinine is too expensive for use as an antiseptic.


Gastro-intestinal tract. - It is very largely used on account of its stomachic properties, chiefly for that variety of indigestion which is the outcome of general ill-health, want of fresh air, anaemia, etc., and not often when the stomach is the organ primarily at fault. The preparations of cinchona bark are very useful for this variety of dyspepsia; they contain quite enough of the alkaloids. The compound tincture has the advantage of containing other stomachics. Iron is very commonly given at the same time to correct the general condition. Quinine is frequently prescribed with the tincture of ferric chloride; there is always enough free acid in this to dissolve any preparation of quinine. Alkalies, especially sal volatile, are often prescribed with solutions of quinine sulphate, but they precipitate the quinine, and therefore mucilage must be used to suspend it. The dose of quinine sulphate or hydrochlorate as a stomachic bitter is 1/2 to 2 gr. .03 to .12 gm. The hydrochlorate is often preferred, as it is the more soluble. Cinchonidine salicylate (not official) is generally preferable to the sulphate as a tonic and an antiperiodic in dose of from 5 to 10 gr.; .30 to .60 gm.

Antipyretic effect. - Quinine was commonly used as an antipyretic, but for the rare occasions on which antipyretic drugs are required, it has now been replaced by more certain drugs, as phenacetin, acetanilid, and antipyrin. It is, however, a very fairly certain antipyretic. It is best given for this purpose in a single dose of 20 to 40 gr. 1.20 to 2.40 gm. for an adult. Such large doses may be prescribed either in cachets, or as a solution of the hydrochlorate, or as the sulphate suspended in milk and at the same time sodium or potassium bromide should be administered to avoid the disagreeable tinnitus which is set up. The diluted hybrobromic acid is an excellent solvent, and, at the same time, will relieve the ringing in the ears. About one or two hours elapse before the temperature begins to fall. Quinine is more efficacious in reducing a temperature just beginning to fall than a rising one. Hence, if possible, it should be administered two or three hours before the time at which previous experience of the particular case shows the temperature will probably attain its maximum; then the fall will be more marked and last longer than if the drug had not been given.

Specific action. - Quinine, and to a less extent the other cinchona alkaloids, have the remarkable property of arresting the paroxysms of malaria fever, because it prevents the entrance of spores into the red blood-corpuscles where only their cycle of development occurs. If 15 to 30 gr. 1. to 2. gm. be taken about one or two hours before the attack is due, it will not take place, or it will be very mild. If a more prompt effect is desired, quinine carbamide (not official), which is very soluble, can be administered hypodermatically; a smaller dose, 5 to 8 gr.; .30 to .50 gm., in an hour or two, is almost invariably successful in preventing the next immediate chill. The same effect may be produced if smaller doses, about 5 gr. .30 gm. have been taken four or five times a day during the period between the attacks. Not only is it thus prophylactic, but the continued use of it is curative. It is also preventive, even if the persons to whom it has been given have never had ague. For this purpose it is administered to soldiers and sailors who have to enter malarious regions, and it is then found that few of them get ague. If the disease is very severe it is best to give single large doses. Clark's powder consists of quinine, 10; powdered capsicum, 4; powdered opium, 1 part. This is given in 15 gr.; 1.00 gm., doses, and is said to be more efficacious in the treatment of ague than larger doses of quinine when given alone.

If a person has once had ague, illnesses that he subsequently suffers from are liable to assume a malarial type. This is especially the case with neuralgia, which is then peculiarly paroxysmal. It is often on the forehead, when it is called brow-ague. In such cases the effect of quinine is frequently very well-marked, and a cure speedily takes place. Sometimes neuralgia which is not malarial is temporarily benefited. Quinine cures ague by acting, while circulating in the blood, as a direct poison to the haematozoa (protozoa), the plasmodium malariae, which infests the blood and is the cause of ague. It has been given for a host of diseases, especially septicaemia, but there is not any evidence that it does good to any except those mentioned. The preparations of the bark contain so little quinine that they cannot be used as antipyretics or antiperiodics.

Lately it has been stated that quinine causes black-water fever; this is a pernicious error, as it will cure this form of malaria.

Quinine should, if possible, be avoided in (1) persons suffering from acute or subacute disease of the middle ear; ( 2 ) those suffering from gastro-intestinal irritation, which it may increase; (3) those people, occasionally met with, in whom quite small doses produce very severe symptoms of cinchonism; (4) Meningitis and (5) Inflammation of genito-urinary tract.

Warburg's tincture is a medicine which has a very high reputation in India for malaria. It has been called Tinctura Antiperiodica. The published formula states that it is a proof-spirit tincture, containing Quinine Sulphate, 80; Socatrine Aloes, 100; Opium, I; Rhubarb, 32; Camphor, 8; with Angelica, Elecampane, Saffron, Fennel, Gentian, Zedoary, Cubeb, Myrrh, and Agaric, as aromatics, with menstruum to 4000. This contains about 9 1/2 gr.; .6o gm., to the ounce; 30. c.c., of menstruum. Dose, 1 to 4 fl. dr. 4. to 15. c.c. It is often prescribed to be made without the Aloes.