A solution of quinine will sometimes, when applied to the nares, arrest an attack of summer catarrh, a malady which appears to he produced by the pollen of plants. The preparation most suitable for this purpose is an aqueous solution of the hydrochlorate (gr. iv— gr. viij— oz j). This should be applied by a large camel's-hair brush, or spray-producer, to the nares and fauces. The utility of quinine in this peculiar disease will be determined by the extent to which the local trouble has proceeded; it can be useful only when the irritation is confined to the nares and fauces.

The aphthous ulceration (muguet) which succeeds to an exhausting entero-colitis, or which occurs in cachectic infants, is much improved by-quinine—a grain or two every three hours. An attack of acute tonsillitis may sometimes be aborted by a full dose of quinine (ten to fifteen grains). This practice is especially indicated in those cases which proceed to suppuration, but the quinine must be administered before pus forms.

The preparations of cinchona are much used as stomachic tonics. In atonic dyspepsia they are employed, like the simple bitters, to promote the flow of gastric juice. In gastric catarrh they relieve that morbid state of the mucous membrane on which the increased production of mucus depends. For these purposes they may be combined with the mineral acids. The best preparation is the infusion; the decoction, although official, is inelegant and faulty. The alkaloid quinine is frequently used for the same purposes, and notably in the gastric catarrh of drunkards, combined with acids. When vomiting of yeastlike material is due to the presence of sarcina, quinine may be used in virtue of its power as a poison to these minute organisms, and as an anti-ferment. In these stomach-disorders other and less expensive drugs may be used with equal advantage. {See Hydrastis.) When there is a relaxed state of the gastro-intestinal mucous membrane, manifested by catarrh, diarrhoea, etc., but without inflammation, the preparations of red bark are more particularly indicated in virtue of the tannins which they contain. The reader need hardly be reminded that the preparations of cinchona are contraindicated in all inflammatory states of the intestinal mucous membrane. Furthermore, if too long continued, they will set up an irritation, and perpetuate the troubles which they were prescribed to remove.

Sometimes it happens that the entero-colitis of children (cholera infantum), which resists every possible combination of astringent and laxative, will yield readily to quinine. The author has seen quinine give prompt relief in the following: A child suffers with tenesmus, and after much straining voids a transparent mucus streaked with blood, but there is no fever nor other disturbance of the bowels, and the stools when passed are natural.

The preparations of cinchona and quinine are very serviceable in that state of the mucous membrane which favors the development of ascarides. After the expulsion of the parasites, these remedies remove the saburral state of the mucous membrane. A combination of purgatives and bitters will correct the following condition of things as they occur in children: A foul breath, coated tongue, capricious appetite, tumid belly, and constipation alternating with diarrhoea.

The use of quinine as a restorative tonic in cases of debility is almost universal. Given in moderate doses—six to twelve grains a day —it promotes constructive metamorphosis. Its utility is due not to any direct action on the blood, but to its stimulant effect on the digestive function, and the retardation of the combustion process. When cinchona or quinine proves irritant to the intestinal mucous membrane, this beneficial restorative action ceases. Iron and arsenic increase the power of quinine to promote construction of tissue and to retard waste.

There can be no doubt in regard to the power of quinine to arrest the inflammatory process in its formative stages. Its utility, given with this view, ceases when the migration of the white corpuscles and the proliferation of the cellular elements of the inflamed parts have taken place, for it possesses no power to cause disintegration and absorption of inflammation products. Administered at the critical moment, a commencing fibrinous pneumonia, a pleuritis, an endocarditis, may be suppressed by a full dose (twenty to forty grains). Its power in this respect is much increased by combination with morphine. If the time have passed for the use of quinine in this way, it is employed with advantage as a restorative tonic in the various inflammatory affections of low type, small doses (two to four grains) being given frequently.

In septic diseases quinine has very important uses. Although the observations of Binz, showing the influence of quinine over septic processes, may not be applicable to the full extent for which he proposes them, there can be no doubt of the good effects in practice of quinine in septicaemia, pyaemia, erysipelas, and puerperal fever. In these diseases, only large doses—five to twenty grains—every four hours, are useful.

The author's experience in the treatment of acute rheumatism does not justify the use of large doses of quinine, as now employed by Briquet and his followers in France. In the hyperpyrexia of acute rheumatism, it is true, large doses of quinine will depress the temperature, but we have less distressing and more effective means for accomplishing this object in the wet-pack and the cold bath. When the acuter symptoms have subsided, and the skin is cool and perspiring, and the pulse weak, quinine in moderate doses—two to five grains—is very seviceable

A careful examination of the large number of facts which have now been accumulated, and considerable personal experience and observation, have satisfied the writer of the inutility of quinine as a means of aborting or shortening the duration of typhus and typhoid fevers. Not only has this remedy little or no influence over the course and duration of these affections, but its irritant effects upon the gastro-intestinal mucous membrane, and its inhibitive influence, exerted through the organic nervous system, upon the heart and lungs, may, in some cases, render it positively injurious in large doses. As a rule, the dryness of the tongue, the diarrhoea, the subsultus, and the delirium of typhoid fever, are increased by it. In certain parts of the United States, the prevalence of a mixed type—typho-malarial—requires, under certain conditions, the use of quinine in continued fevers. But it becomes less and less effective as the typh-element predominates. When there are evidently true remissions—and not merely the rhythmical morning remission and evening exacerbation characteristic of typhoid—quinine is indicated, and it is most effective when administered in an occasional large dose during the remission. When there is a condition of hyperpyrexia, or of continuously elevated temperature, which endangers life by parenchymatous degeneration and cardiac or cerebral paralysis, quinine in antipyretic doses renders an incontestable service. This opinion of the author is fully confirmed by the committee of the Clinical Society of London, who find that large doses of quinine have a marked effect in reducing the temperature in pyrexia, and that, although, with the exception, perhaps, of certain cases of rheumatic fever in which the temperature is high, no decided evidence has been obtained to show that quinine has any influence in shortening the attack of a specific disease such as typhus or scarlet fever, yet from the marked effect on the temperature and pulse there is reason to believe that at the critical stage of acute disease, when pulse and temperature are high, a large dose of quinine may be employed with benefit. Jürgensen, Ringer, Liebermeister, and other authorities, and a vast clinical experience in all civilized countries, are now agreed in respect to the fever-reducing power of quinine and to the absence of ill results from large doses (especially Liebermeister). Liebermeister, indeed, says, if he were restricted in his choice to one antipyretic, he would select quinine. The quantity necessary to effect a decided reduction of the body-heat in fevers is determined by the age, the amount of disturbance, and the individual susceptibility to its action. In general, it may be stated that from twenty to sixty grains will be required. The antipyretic effect is more decided if it is given toward the close of the exacerbation or during the remission in typhoid or other fevers. The duration of the effect is "from one to forty-eight hours" ; consequently, a repetition of the dose will be necessary, if it is desired to maintain the reduction of the temperature.