In the so-called pernicious fever, it is agreed on all hands that the safety of the patient is secured only by the prompt use of large doses (twenty to sixty grains), and administration by the stomach, rectum, and skin may be in turn or simultaneously resorted to.

In chronic malarial infection, important changes have been produced in the intestinal canal, liver, spleen, kidneys, cerebro-spinalaxis; the paroxysms of fever occur irregularly; various abnormal manifestations of the infection take place (dumb ague, enlarged spleen, etc.). Under these circumstances, quinine is less curative than when the infection is recent, and the paroxysms will recur from time to time notwithstanding its use, unless these structural alterations are corrected. In chronic malarial disease, salicylate of quinine and salicylate of cincho-nidine are especially effective. Rx Cinchonidinae salicylat., 3 ij ; acidi arseniosi, gr. j; ferri sulph. exsic, Эj. M. Ft. pulv. (wafers) no. xx. Sig.: One three times a day. Also: Rx Chinoidin., 3 ij; quininae salicylat., 3 j; ferri sulph. exsic, Эj. M. Ft. pil. no. lxxx. Sig.: Two pills three times a day. Rx Quininae sulph., chinoidinae, āā 3 j ; res. podo-phylli, gr. v; ferri sulph. exsic, 3 ss. M. Ft. pil. no. lx. Sig.: Two pills three times a day.

In periodical affections of malarial origin, quinine is equally as effective as in the periodical febrile diseases, but somewhat larger doses are necessary. A difficulty of diagnosis often arises in these diseases, for the reason that the neuroses are irregularly periodical in their manifestations, when not malarial in origin. The existence of a malarial cachexia, and the more uniform periodicity in the recurrence of the paroxysms, will enable the practitioner to distinguish the neuroses of malarial origin from the other functional disorders of the nervous system. The following group contains the disorders of the sensory nervous system caused by malaria: tic-douloureux, cephalalgia, cer-vico-brachial neuralgia, cervico-occipital neuralgia, dorso-intercostal neuralgia, lumbo-abdominal neuralgia, mammary neuralgia, crural neuralgia, gastralgia, enteralgia, hepatalgia, nephralgia, hysteralgia, ova-ralgia, sciatica, angina pectoris. The following motor disorders, also, are produced by malarial influences: epilepsy, chorea, stricture of urethra, hiccough, laryngismus stridulus, asthma, summer catarrh. These neuroses may occur as an expression of malarial infection, being substituted for the ordinary chill, fever, and sweat, or they may assume the orderly periodical character in consequence of having occurred in an organism already under the influence of the malarial cachexia. If they are of malarial origin, the specific action of quinine will speedily prevail against them. These malarial neuroses require large doses of quinine, and the same fact is true of all irregular manifestations of malarial infection. Ten to twenty grains, according to the severity of the attacks and the obstinacy with which they recur, are necessary, and the paroxysms should be anticipated by the exhibition of the remedy from three to five hours before the expected time. In cases of malarial neuralgia, the curative effect of quinine is enhanced by combination with morphine, either in the same prescription or by simultaneous administration of the latter subcutaneously.

Diarrhoea, dysentery, jaundice, and hypertrophy of the spleen occasionally occur in the periodical form, or are due to the immediate influence of paludal miasm. Under these circumstances quinine affords relief without the use of any other remedy. Very frequently the diarrhoea, dysentery, and jaundice are results of structural alterations in the liver and the glandular apparatus of the intestine, and are not merely functional disorders which quinine may remove. In malarial enlargement of the spleen, quinine is supposed to be especially effective; but quinine exhibits a curative power only in cases of simple enlargement, and does not affect that condition known as "fleshy spleen," or chronic splenitis, of inflammatory origin.

Haematuria, when distinctly intermittent and arising from malarial infection, is cured by quinine, but large doses are necessary. According to Karamitsas, sometimes haematuria is caused by this agent.

Cases of cerebral disease, occurring in weak and anaemic subjects, are sometimes much improved by small doses of quinine. The author has observed great relief by the use of this remedy in the following group of symptoms, occurring in men advanced in life: Headache, vertigo, failure of memory, and despondency, associated with a slow pulse, an atheromatous degeneration of the vessels, puffiness of the eyelids, and dilatation of the superficial veins of the head. From three to ten grains daily may be given with advantage, the effect being to remove that sluggishness of the intra-cranial circulation on which these symptoms depend. In insanity, especially the puerperal form, when there is much weakness, and the skin is cold and sweating, quinine is very useful. When there is a condition of adynamia—the usual state—in delirium tremens, small doses of quinine assist materially in tranquillizing the patient. In that preliminary stage known as "horrors," characterized by restlessness, tremor, nausea, and anorexia, quinine, with a mineral acid, renders important service by restoring the digestive function, and by giving steadiness to the cerebral motor centers.

Although headache (hemicrania) and neuralgia of malarial origin are cured by quinine, by no means equally successful results follow the use of this remedy in ordinary headache and neuralgia. Quinine is largely employed, it is true, in these affections when not caused by malaria, but it is useful only when anaemia is present and is causative. The same remark is true of epilepsy and chorea.

An attack of acute catarrh may often be entirely aborted by a full dose (ten grains) of quinine and morphine (one half a grain), if given at the incipiency of the attack. After the acute symptoms have subsided, quinine is very serviceable in hay-asthma. Diphtheria being an adynamic disease, quinine is used by the stomach with a view to its restorative action, and in the form of spray to arrest the spread of the exudation in the fauces. The power of quinine to kill bacteria and micrococci renders its local use a rational measure in a disease characterized by an enormous multiplication and diffusion of microeocci.

Laryngismus stridulus, a reflex spasm of the muscles of the larynx occurring in rickety, ill-fed, and anaemic children, may be prevented recurring by the use of quinine in the intervals between the attacks.. Quinine is one of the remedies which is used in membranous croup, but the reported successes were probably cases of spasmodic croup. There can be no doubt regarding the good effects of quinine in asthma, after the severity of the paroxysms has somewhat abated, as an. apyretic in the fever which succeeds, and as a restorative tonic. It is also the most useful tonic which can be employed in chronic bronchitis, with profuse expectoration (bronchiectasis). The hectic fever and sweats of phthisis are prevented by large doses (fifteen to twenty grains) of quinine, but this remedy really has no influence over the course and progress of the disease.

In skin-diseases, when there is present a lowered condition of the vital forces, quinine is indicated. It is the most valuable remedy in erysipelas and erythema nodosum. It is a curious fact that in many subjects a full dose of quinine will cause an erythema, with dilated pupils, phenomena closely analogous to those produced by belladonna Ecthyma and impetigo, usually arising in a feeble state of the assimilative functions, are cured by quinine.

Quinine is largely employed in surgical affections, to sustain the powers of life during protracted suppuration, and to check the formation of pus. It is the most generally prescribed remedy for surgical fever. A full dose of quinine, given before the operation, may prevent the chill and fever which succeed in some subjects to the operation of catheterization.