In Chorea quinine has never appeared to me to exert more than a subordinate and almost accidental curative power. We now and then seem to hit, quite by chance as it seems, some ill-understood want of the organism, and in this way get an apparent quinine-cure. But to any one who has been elated by a success of this kind, there is more than likely to come disappointment, from the total failure of the medicine in a long series of subsequent cases.

In Chronic Alcoholism, on the contrary, and in some varieties of chronic Insanity, quinine is much more frequently useful; and it may indeed be said that in all cases where the problem is to slowly raise the nervous tone, quinine has a steady and permanent value. It is useless to administer it in large quantities; from two to six grains daily is enough.

The above is a fair summary of the more important uses of quinine which are called for by the occurrences of every-day practice. There remains a more miscellaneous group of disorders, in some of which it is likely that quinine will prove more beneficial than is at present generally supposed. In others it is already known to be of great value.

In all Gangrenous conditions, whether the result of ordinary inflammation badly complicated, or of a specific or septic poisoning, quinine has often proved itself to be of value. It is commonly said that cinchona in infusion acts better than quinine in those conditions, but such is not my experience, even when using the sulphate, while it is probable that when the hydrochlorate comes into use in this country we shall still further get rid of any disturbing influence upon the stomach.

In Laryngismus Stridulus we have a most valuable remedy in quinine, and it is probably an erroneous idea that the action of the drug in this disease is simply a nervous one. Laryngismus is part of a general abnormal state in which the whole organism is affected in a peculiar manner, and in which, with great frequency, we observe some of the symptoms of rickets. In what way it comes to pass that quinine so benefits this general state we are not able to tell; but it has appeared to me that we can trace, in many cases, a rapid alteration of that fault of assimilation by which the phosphates, instead of being applied to the nutrition of the tissues, are thrown out uselessly in the urine. I do not hold with some authors that it should be given only in the intervals of the paroxysms and in very large doses. I believe it better to give it in small repeated doses, and without interruption, using enemata if the child cannot swallow.

In Asthma, which is also usually considered, relatively to any beneficial influence of quinine, a merely nervous disease, it is probable that the action of the remedy is not so simple or so limited. We have the high authority of Dr. Hyde Salter for its use as the best of all tonics; but he usually gave it with iron and mineral acids, and this agrees with my own belief that the good effect of the drug is exerted not only on the nervous system, but also, and probably more decidedly, on the general nutrition of the body and on the digestive process. It is one of the greatest troubles of asthmatics that they cannot take more than a very small quantity of food at once without the danger of exciting a paroxysm; under the influence of a quinine or a quinine and iron tonic this disability often much diminishes, to the great benefit of the patient.

In Erythema Nodosum quinine has long been noted for its beneficial action; indeed it is usually the only remedy needed in addition to a few days' most; and its use certainly renders the course of the affection much shorter than when left to nature. We should probably be justified in reckoning this as one of the examples of the action of quinine upon the nervous system, although we are unable to prove the dependence of erythema nodosum on purely nervous causes.

In Urticaria quinine is only useful in special cases. The tendency to nettlerash is very personal; in the commoner kind of cases the individual is always liable to an attack after eating freely of some particular food, such as shell-fish, salmon, or strawberries. To such patients, when they have thus brought on an attack, we need only give an emetic, or an emetic and a purge. But there is a kind of chronic urticaria in which, though an attack may be more easily brought on if indigestion be present, the true source of the disease lies evidently in some peculiarity of the nervous system; and medicines directed to the digestive organs cannot be expected to do much good.

In some of these cases arsenic is the best remedy; but in most of them the long-continued use of quinine and mineral acids overcomes the tendency more surely.

In Insanity it would be wrong to speak of quinine as exerting any special ef'fect; but there are many cases in which its tonic effect, espe.

cially when combined with that of iron (as Dr. Maudsley observes) is very useful.

As a General Tonic it is universally agreed that the condition in which quinine produces most decided benefits is that in which the flesh is flabby and the skin too perspiring.

As a Tonic to Digestion in the numerous cases of atonic dyspepsia, quinine is probably inferior, on the whole, to cinchona in conjunction with mineral acids. But there are affections of the stomach in which the dyspepsia is accompanied by dilatation of the stomach and symptoms of fer-, mentation of the retained food, which after a time is passively vomited, often in immense quantity: in this disease there is much reason for thinking that the fermentation is not merely an accidental consequence of the primary affection, but that it directly aggravates the mischief to such an extent as to become almost the more important part of the morbid condition. Upon this supposition various antiseptic and antifermentative remedies have been proposed, but it is probable that none of these has a more powerful action of the kind required than quinine, for reasons which have already been stated.