ε. As an Oxytocic, or stimulant of the uterine movements, quinine has yet to give its absolute proofs, but a large amount of evidence has been collected, during the last few years, in favor of the belief that it does possess this action. The latest facts on the subject are those related by Dr. Rancillia.1 Remarking that it has often been observed by French and Italian physicians that quinine administered to pregnant women suffering from intermittents caused abortion, but that this had been attributed by other authorities to the direct influence of the malaria, and not to the quinine, Rancillia states that in his practice as a veterinary surgeon at Caen he had often found the labor pains of bitches brought on very actively, even when ergot had failed, by the administration of one and one-half grain doses of quinine at short intervals. This is a matter which certainly deserves to be practically tested by all accoucheurs.

The Therapeutic Action of the other Cinchona Alkaloids needs but very few words after what has been said of the result of recent inquiries. The extensive comparative trials which were made by the Indian Commission, already mentioned, brought out the general fact that all the four alkaloids, quinine, cinchonine, quinidine, and cinchonidine, act essentially in the same manner against intermittents: and as regards activity, the only point of consequence is that cinchonine is a good deal weaker than either of the other three. When we take these facts in conjunction with the valuable observations of Dr. Baxter, which show that the same relations exist between the purely physiological activity of the respective alkaloids, it seems legitimate to regard the question as practically settled; and all further questions concern only the matter of expense, or such special points as the facility with which one or other alkaloid can be prepared for hypodermic use.

The Therapeutic Action of Kinic Acid is still in a very unsettled position. Of course its primary interest arises from the fact that, in cinchona bark, quinine exists in combination with it, and that this kinate of quinine is a particularly soluble salt. At present we cannot say that there is any other virtue in kinic acid beyond this.

The Therapeutic Action of Kinovic Acid is probably much more important. The researches of Kerner (1863) first brought this acid prominently into notice, although it had been thoroughly investigated by Hlasiwetz, from the chemical side, in 1859. Kerner directed attention to the fact that kinovate of lime is the active principle in Deloudre's Extract, a preparation successfully employed in various European countries and in India in diarrhoea and dysentery. It has been further stated that kinovate of lime is useful even in true intermittents; but this requires confirmation. Since the year 1869, when kinovate of lime was introduced into London by Messrs. Hodgkinson, a few physicians have occasionally employed it; but there has been no general adoption of it, and it seems to have been forgotten. I cannot speak from personal experience, but it appears that this remedy may be given in doses of from ten to thirty grains. One circumstance is worthy of special mention: it is suspected by some of the continental authorities that kinovic acid is especially extracted in the making of the cold infusions of bark, and it is known that many good authorities have preferred this preparation to any other, especially in febrile conditions where the alimentary canal was irritable.

1 Practitioner, January, 1874; Union Medicale, 1873, p. 800.

The Therapeutic Uses of the Tannic Acids of Bark have not been studied with any care, although they well deserve it. It is evident that in them resides the powerful and very peculiar kind of astringency which the cinchonas possess, and which enables us at times to administer bark where we could give almost no other tonic. The separate trial of cincho-tannic and kinovi-tannic acids, as remedies for diarrhoeas and other fluxes, is much to be desired.

Preparations and Dose. - Cinchona Flava, gr. v. - xx. (.30 -

1.20.); Extract. Cinchon., gr. ij. - xv. (.12 - 1.); Extr. Cinchon. Fluid., m v.-xx. (.30 - 1.20.); Tinct. Cinchon., 3 ss. - ij. (2. - 8.): Tinct, Cinchon. Co., 3 ss. - ij. (2. - 8.); Decoct. Cinchon. Flavae.

Cinchonaceae Cinchona Part 11 37

- ij. (30. - 60.);

Decoct. Cinchon. Rubrae,

Cinchonaceae Cinchona Part 11 38

- ii. (30. - 60.); Infus. Cinchon. Flav., ij. (30. - 60.); Infus. Cinchon. Rub.,

Cinchonaceae Cinchona Part 11 39Cinchonaceae Cinchona Part 11 40

- ij. (30. - 60.); Quiniae Sulphas; Quiniae Valerianas; Piluke Quiniae Sulphatis. - No definite dose or number, as the circumstances under which they are given vary so greatly.

Of Quinine, the form most commonly employed is the neutral sulphate, 2C20H14N2O2,7HO, which, from its insolubility in water, has to be dissolved by the acid - a mineral acid when the medicine is to be given in liquid shape. Whenever we can give quinine in the solid form we may quite trust the stomach fluids to dissolve it, and for most persons this answers very well. Any one who cannot conveniently swallow pills can either take one of the convenient preparations of chocolate which are now made, with a definite dose in each piece, or can effect the same purpose in a rough and ready fashion by enclosing the dose of solid quinine between the two halves of an ordinary chocolate "drop" and eating it up. Chocolate is exactly the right thing for covering the taste of quinine

By patients who are severely ill with acute disease we often cannot get sweet things taken, and if we have any difficulty in getting the requisite doses taken by the mouth it is better to administer them in enema. But the sulphate is not a good form in which to administer quinine in some acute diseases, as it is not sufficiently well borne by the stomach.