The increasing use of quinine hypodermatically requires further consideration of this subject. In pernicious intermittents and remittents, when life is put in imminent danger, the most speedy and effectual way of introducing the remedy must be employed. Besides the hazards due to the intensity of the poison, an irritable stomach and rectum prevent the introduction of the remedy by either of those channels. The subcutaneous method then becomes most important. Again, in obstinate and repeatedly relapsing intermittents, the introduction of the remedy by the skin imparts to it greater curative power. In enlarged spleen (ague-cake), malarial jaundice, with great irritability of the stomach, and a catarrhal state of the gastro-intestinal mucous membrane, the subcutaneous method becomes necessary, or, if not essential, is much more effective. Quinine and the sulphate simply suspended are not adapted to subcutaneous use. Several cases of tetanus have been reported from New Orleans (Sale), and two cases occurred in one regiment of the British Indian Army from their use in this way. The salt employed for hypodermatic use should be sufficiently soluble that no undissolved particles be thrown under the skin. Various solutions have been proposed. The muriate is more soluble than the sulphate — dissolves in twenty-four parts of cold water, and about three parts of alcohol. One grain will dissolve in about fifteen minims of hot water, and in a much less quantity of alcohol-and-water, but alcohol is irritating. Lente's solution, which is much employed in New York, is prepared as follows: Rx Quininae disulph., grs. 1 ; acid, sulphuric, dil., τη c ; aquae font., oz j ; acid, carbolic, liq., τη v. Solve. This contains six grains to the drachm. Dr. Lente directs that the quinine and water be heated to the boiling-point when the acid is-added. The solution is then filtered into a bottle and the carbolic acid added. Below 50° Fahr. it must be warmed before using. A solution of kinate of quinine is much used at Guy's Hospital at the strength of one to four. The kinate is obtained by decomposing sulphate of quinine with the kinate of barium. The mode of preparing the solution is as follows: Put into a beaker 3 vj of distilled water and 3 ij of kinate of quinine, and heat until the salt dissolves, which it does almost immediately, and then add enough distilled water to make up to oz j. The disadvantage of so concentrated a solution is the incrustation, by evaporation, of the bottle and syringe with the solid kinate. The sulpho-vinate of quinine is very soluble—one part in three of water at 60° Fahr.—and is readily prepared by double decomposition between the alcoholic solutions of sulpho-vinate of sodium and sulphate of quinine. Gubler advocates the hydrobromate, as follows: Rx Quininae hydrobromat., grs. xlviij; aquae destil., f oz j. M. Dissolve by heat if necessary. Ten minims contain one grain.

Recently a new compound salt of urea and quinine has been proposed, and it seems to possess distinct advantages over every other preparation: it is designated quinia bimuriatica carbamidata, and is formed by Drygin from a combination of twenty parts of muriate of quinine, twelve parts of muriatic acid, and three parts of urea. The resulting salt is soluble in equal parts of water. The utility of this compound is not entirely theoretical. Practical trials made at Hamburg have demonstrated its fitness for hypodermatic use. A fifty-percent solution has usually been employed, and a half to three syringefuls (τη xv to 3 jss) injected. The local irritation is represented as slight. Very favorable reports have been published in respect to the utility of the hydrobromate brought forward by Gubler. In the hands of Raymond, Soulez, and others, intermittents are said to have ceased after two injections of three grains each of this salt. The usual method pursued was to inject one and a half grain of the hydrobromate twice morning and evening, and, although six to twelve grains were usually successful, in one case thirty grains were required. It has also been employed in the treatment of acute rheumatism.

Quinine in solution is applied in various affections of the fauces by atomization. In diphtheria especially have good results been produced.

A saturated solution of the muriate or of the bromide may be thus employed. There can be no doubt that a solution of quinine applied to the nares may be very beneficial at the onset of hay-asthma, as first shown by Helmholtz. The author has seen several cases benefited greatly; but to achieve success the applications must be thorough and timely. The secret of any good effects it has, is afforded by its toxic action on germs, and possibly on the pollen of certain grasses, to the presence of which the irritation of the air-passages is ascribed.

The author is indebted to Dr. W. R. Gray, of Orange, New Jersey, for a private communication in which he states that he has successfully used quinine by inunction— Э j of quinine to oz j of lard—in the case of children especially. The ointment should be thoroughly rubbed in over the abdomen and at the flexures of the joints.