In those affections which indirectly result from an original malarial poisoning, it is of much consequence to determine the manner in which quinine may be most usefully employed.

In Neuralgias of malarial origin there is generally a much more regular periodicity of the attacks than in the neuralgias which are independent of this cause; and advantage should be taken of this fact to apply the principles already laid down in speaking of the intermittent fevers. Instead of continuing a number of small daily doses, it is far better to reserve the drug for employment at a time when a paroxysm may be confidently expected shortly to occur. About an hour before the time of the anticipated attack, a heavy dose (five to fifteen or even twenty grains, according to the degree of the patient's previous familiarity with the drug) should be administered; it is not a bad plan to give the quinine in a glass of sherry. Seldom does it fail to produce decided effects; the paroxysm either ceases altogether, or is much weaker than usual. The same plan is pursued before the next expected recurrence; and the neuralgia rarely fails to disappear entirely after a very few such repetitions of the dose.

The above plan is most suitable to severe cases with short intervals; in milder examples of the disease it may doubtless be sufficient to impregnate the system with a daily amount of three to six grains in divided doses.

Epilepsy of malarial origin is very effectively combated with quinine; few things are more remarkable than the uselessness of this drug in common epilepsy, compared with its magical operation in the malarial form of the disease. Here we cannot put in force the principle of single large doses in anticipation of an attack; the proper method is to give regular moderate doses (about six grains a day), for several weeks in succession. So important are the benefits secured by the quinine treatment in cases where malaria has had any share in the production of the disease, that even a small probability that such has been the case ought to induce us to try this remedy; and the mere fact that the patient has resided for some length of time in a malarious country, even though he may not have had distinct malarious symptoms, is ample ground for essaying a cure by quinine.

1 During the whole period of Messrs. Howards & Sons' carrying on the manufacture of quinine they have never known a case of ague or intermittent fever amongst their workmen which could by any possibility be referred to the nature of their employment, nor have they ever heard of such a case. Messrs. Howards & Sons' is the oldest and largest firm in that branch of trade.

β. In the so-called Septicaemic fevers, a large and not very accurately determined class, but of which the principal representations are well recognized, quinine has a part to play only second to that which it fulfils in the malarious fevers; and here again much depends on the mode of administration. With regard to the individual members of this group of diseases, it is true that there are other remedies that frequently prove more directly and specially effective; thus in erysipelas, at any rate in the early stages, the perchloride of iron is the true, and usually successful remedy; and in puerperal fever, as we have already mentioned, the action of aconite is frequently so serviceable as to leave nothing to be desired which drugs have any chance of accomplishing. But in the whole series of this variety of blood-poisonings, quinine holds a permanent place as a remedy; for whether in erysipelas, in surgical pyaemia, or any other of the infections which are specially connected with the absorption of putrid matters or of their emanations, when once a certain gravity of organic disturbance is reached - when the fever is excessively high, and the nervous system profoundly agitated and depressed - there is scarcely anything medicinal which offers the same chance of reducing the pyrexia, of relieving the inflammatory complications, and of sustaining the vital powers during the struggle, as quinine given in large and repeated doses. It is important to remember that both the reduction of actual temperature and the excessive combustion processes which lead to the generation of abnormal heat, are aided in high degree by the simultaneous administration of alcohol; and Socin has recently shown that alcohol helps the organism to tolerate doses of quinine, which would otherwise produce inconvenient or even dangerous toxic effects.

In the treatment of the ordinary Infectious fevers quinine holds a more doubtful place than in that of the so-called septicemic fevers. In all of them the administration of very large doses of the drug (five to twenty grains or more, frequently repeated) will often produce a notable reduction of the symptoms, and especially of the febrile temperature. But we cannot be sure that any considerable influence is exerted on the general course of the disease; often a striking, immediate, anti-pyretic effect, even many times repeated with unvarying certainty, seems to count for little or nothing in the final event. The example of typhoid fever serves well to test this matter. In our own country the use of quinine in this disease was introduced but a short time ago by the late Dr. Fuller, and both here and abroad it has been fully tested in recent years. That the treatment is at least harmless seems to have been fully established; and in regard to dosage and mode of administration, it may be stated that as much as three or four drachms have been given in divided doses during the twenty-four hours, without injury, and often with benefit. Upon this point it is interesting to quote the recent authority of Dr. Clifford Allbutt, who has continually used quinine largely in febrile diseases, ever since its recommendation by Dr. Fuller some fifteen years ago. In typhoid fever, however, neither Dr. Allbutt nor any other high authority seems to claim the proof either that the disease is shortened in course or that its more serious consequences are materially hindered. Neither those who place their main reliance on the removal of heat per se, nor those who think it most important to strike at the combustion processes, which are the origin of abnormal heat, appear now to believe that quinine alone will effect any very material purpose. The same may certainly be said to be even more true of typhus fever. There are, however, some of the acute fevers which apparently benefit far more by the use of quinine; this is especially true of scarlet fever, as was pointed out some years ago by Dr. Peter Hood. In this disease it does appear to be the fact that quinine used in moderate doses from the first has a remarkable effect in averting the graver complications. It is probably not a merely accidental coincidence that quinine thus proves most beneficial to that member of the group of contagious fevers which has some of the closest relations, and even a partial convertibility, with such septic disorders as puerperal fever.