1. In all cases previous to the administration of Quinine, it is advisable to give a purgative or emetic, or both, so as thoroughly to remove all crude matters or biliary accumulations from the alimentary canal.

2. The fluid form is the best, and its activity and certainty of operation are greatly increased by the addition of a few drops of Acid. Sulph. Dil. (one drop to each grain). Mr. Squire, however, recommends that when a large dose (gr. x.) is to be taken, that it be merely suspended in water and not dissolved, as the bitterness is not then so intense.

3. Its action is rendered more certain and speedy by being given on an empty stomach.

4. When the bitter taste is objectionable, as in the case of young children, Amorphous Quinine, which is insoluble in saliva, but readily soluble in gastric juice, may be advantageously substituted.

5. To Disguise Its Taste, It May Be Given In Infus

RosAe Acid., which, although it produces a turbid and unsightly mixture, does not interfere with its operation. The same remark applies to strong coffee, which is a good vehicle for its exhibition. Another good vehicle for Quinine is the Infusum RosAe cum Acido Nitrico of Mr. Squire (Red Rose petals broken small, oz. ij.; Dilute Nitric Acid fl. oz. ss.; Cold Distilled Water fl. oz. xx. Intuse two hours, frequently stirring; strain, and add powdered Sugar oz. j.). This, with Quinine, makes a bright and attractive mixture.§ fannin effectually disguises the taste (gr. ij., Quinine gr. x.).

6. When, from irritability of the stomach, it cannot be given by mouth, it may advantageously be administered in the form of enema, in two or three ounces of any bland fluid. Or it may be effectually applied endermically or hypodemiically.

* Pereira, vol. ii. pt. 2, p. 119. Garrod, Ess Mat. Med. and The-rap., pp. 222, 223.

Companion to Pharmacopoeia, p. 154.

§ Comp. to Pharm., p. 159.

7. Combination with other remedies, particularly with Opium, Arsenic, or the Sulphate of Iron, appears greatly to increase its efficacy.

8. If, under its continued use, fulness of the head, or a buzzing noise in the ears, be experienced, the medicine should be discontinued.

9. When Quinine fails, Cinchona will sometimes prove effectual; or it may be advantageously replaced by Arsenic, Sulphate of Iron, or some other anti-periodic.

10. It is advisable to continue its administration some time after the disease appears to be cured.

Contra-indications. 1, Plethora, with a determination of blood to the head; 2, cerebral affections generally; 3, inflammatory states of the intestinal canal.

2321. Therapeutic Uses

Fevers. - In Intermittent Fevers, Quinine may be regarded almost as a specific in uncomplicated cases. If given in doses of gr. ij. - iv. or more, every four or five hours during the intermissions of the fever, it proves almost uniformly successful. In order, however, to obtain these results, it is necessary to ascertain, by careful examination, that no hepatic or visceral disease exists; such complications rendering the remedy not only inert, but injurious. It is, therefore, advisable to commence the treatment with a purgative or emetic, or with both. Mr. Eyre,* in his valuable report on the Goomsur Fever, in 1847, states that he often found Quinine fail, and that he has never seen it otherwise than injurious, when there exists a disordered state of the primAe viae; an observation which accords with the experience of most Indian medical officers. In other instances, he observes, in which the remedy failed, bilious accumulation in the bowels, or congested liver, was found to be present, on the removal of which, the fever often subsided spontaneously; or a few moderate doses of Quinine proved sufficient to effect a cure. If these, however, are allowed to remain unheeded - if complications of important viscera, particularly of the brain, exist - if the pulse continue frequent, and the tongue be foul and loaded, whatever may be the state of the skin, no good effects can generally be expected from the administration of Quinine: if it does not prove inert, it will be injurious. These remarks, as applying to one of the most obstinate of all Indian fevers, merit especial notice. Other modes of administering Quinine in inter -mittents have been proposed, the advocates of each mode declaring it to be "the most effectual." They are as follows: -

a. It should be given in large doses, not only during the intermissions, but also during the hot stages of Fever. This plan, originating in America, has found its advocates in India. Amongst others, Drs. Hare, Ford,t and Macrae,! have recorded their opinions of its efficacy. Dr. Macrae, in an able paper, supports his own by the opinions of others, drawn from various sources. Dr. Upshur, of Virginia, administered gr. x. every hour, until the patient complained of noises in the ears, &c, and continued its use, irrespective of the existence of pyrexia. Of 105 cases thus treated, not one died, and in only three were there any unpleasant symptoms. Dr. Bell, physician to H.M. Mission in Persia, administered Quinine at stated periods, irrespective of the presence or absence of fever, and he affirms that he found the practice highly successful. M. Mailot, physician to the French army in Algiers, employed Quinine in large doses (in one case 148 grains in twenty-four hours), in the hot as well as the cold stage, with decided effect. Dr. Ford, out of 2,294 cases in which this treatment was followed, only lost ten, or about 1/2 per cent.: but the value of this return as evidence of this mode of giving Quinine, is greatly weakened by the fact that he gave Mercury at the same time, so as to produce soreness of the mouth.

* Medical Reports, Madras, 1850, p. 129.

Indian Register of Med. Sciences, Aug. 1848. Ibid., June 1848.

b. It should be given in one large dose, immediately after the paroxysm of Fever. Dr. Elliotson advised this method, and it has very commonly been adopted in some parts of America. Dr. Holmes* states that, in the severe intermittents which occur in the Southern States of America, a large dose of Quinine, given immediately after the fever has subsided, effectually checks any further paroxysms. The usual dose is from xv. to xx. grs. for an intermittent, and from xxx. to 1. grs. for a congestive fever. In one case he gave lxxx. grs. for a dose ! He never administered divided doses of Quinine; one large dose, in his opinion, being more efficacious than any number of small ones. Dr. Macrae states, that of seventy-four cases thus treated (gr. xv. - xxv. for a dose), a single dose was required in fifty-five, a second in thirteen, and a third or more in six cases. Dr. Mackinnont also bears testimony to the value of this treatment, considering that the most effective and most economical mode of administering Quinine is to give it in a single large dose (5ss.) at or towards the termination of the sweating stage. A similar mode of administration is likewise praised by Dr. Mactier§ and Dr. Murchison.|| Dr. Short¶ states that one dose of grs. xxv. in Europeans, and grs. xx. in natives, given immediately after the sweating stage, has been found quite adequate to arrest the fever.