* A case has fallen under my notice, strongly illustrative of the dangerous effects which may arise from very large quantities of sulphate of quinia in this lever. 1 was called in consultation to a case of fever, which the attending physician considered, and was treating as au ordinary bilious remittent. I thought 1 had convinced him that it was enteric or typhoid fever, and we separated after agreeing to a course of treatment consonant with this view. It appeared, however, that he was not really convinced; and, determined apparently to prove me in the wrong, he directed between thirty and forty grains of the sulphate of quinia to be administered during the day. There had previously been no alarming symptoms in the but, on the repetition of my visit next day, I found the patient in violent convulsions, and within twenty-four hours he died comatose. (Note to the second edition).

In puerperal fever, sulphate of quinia, in large doses, is asserted to have been employed with extraordinary success; and, in epidemics of that affection, it is believed to have been used advantageously as a preventive. M. Beau, of Paris, is among those who strenuously advocate the use of the medicine in this frightful disease. It is given in the quantity of from fifteen to thirty grains in the day, or sufficient to induce the decided effects of quinia on the system. (Ann. de Therap., 1858, p. 178).

Acute Rheumatism. Peruvian bark was long since employed as a remedy in acute rheumatism in Great Britain; but the practice had been abandoned, and only came again into general notice after the publication of the results obtained by M. Briquet, and other French physicians, about the year 1842, with large doses of sulphate of quinia in that disease. There can be no doubt that, under the use of this salt in the quantity of half a drachm, more or less, given daily in divided doses, cases of acute rheumatism have often yielded, and entered into convalescence, without any serious inconvenience, at a much earlier period than they ordinarily do if left alone. Very soon after the system has come under the full influence of the remedy, the pains and swelling abate, sleeplessness is relieved, and the pulse is reduced in frequency and force; and the patient, in most instances, when the disease is uncomplicated with inflammation of the internal organs, as of the heart, will become convalescent in about ten or twelve days from the commencement of treatment. Sometimes, however, as under every other treatment, the complaint is much more prolonged, and, when complicated with pericardial or endocardial inflammation, extends to an average period of sixteen days or more; though it is asserted that these inflammations, especially if encountered by general or local bleeding, afford no contraindication to the use of quinia. According to Briquet, the cases least benefited by the sulphate of quinia are those of a plethoric character, in which the inflammatory fever is intense, and the pulse full, hard, and frequent; while those in which it proves most advantageous are lymphatic subjects, or those weakened by previous disease, or excessive depletion, with pale skin, and a very frequent but not well-developed pulse. This is exactly what might have been expected, from the views of the action of sulphate of quinia here advocated, and quite contradictory to the notion of its direct sedative power. The medicine suppresses the morbid phenomena by an over-excitement, and consequent diminution of the excitability of the nervous centres through which the phenomena are induced, and not by a direct sedative influence on those centres, or on the circulation. But in this very circumstance exists the danger of the practice. Should there happen to exist already in these centres, as now and then happens in acute rheumatism, a vascular irritation or positive inflammation, or a strong tendency to it. then the fear is that quinia may aggravate this condition, and lead to fatal inflam-mation within the encephalon. This is asserted to have happened in several cases, in consequence of which, the practice has not been generally adopted by the profession; and I am not inclined to recommend it. The only circumstances under which I should think it advisable to administer quinia, in acute rheumatism, not complicated with miasmatic fever, are those of general debility, and especially as indicated by profuse sweats, occurring during sleep, and not at other times. As before stated, I have for a long time been in the habit of employing, and of recommending, in my lectures, the use of quinia freely in this condition, and have almost always found it promptly effectual in relieving the symptoms, and generally curative.

In chronic rheumatism, the remedy is less efficient than in the acute; but, when carried to the amount of thirty or forty grains daily, it has sometimes proved effectual, especially in cases in which the inflamma-tion has been disposed to change its seat, and thus approach the acute in character.

Gout is affected by quinia in a manner very similar to its mode of action in rheumatism. In the acute form, large doses of it will sometimes suppress the local inflammation; but the disease is not subdued, and there is always danger of its appearance in some other of its numerous shapes. The practice, therefore, is almost never resorted to But, in debilitated states of the disease, the medicine may be used advantageously, as a tonic, and, in the nervous forms, is not unfrequently useful as an antiperiodic or superseding remedy.

In the phlegmasiae, or local inflammations attended with symptomatic fever, quinia has been thought by some to have a curative effect, in large doses, through its sedative influence. But, for the cure of inflammation, something more is necessary than to reduce the force and frequency of the pulse. Otherwise digitalis would be among the most efficient remedies in that affection, over which, indeed, it has been found to have little influence. An important indication, in the phlegmasiae, is to reduce or alter the quality of the blood, as well as to lessen the quantity, or the force with which it enters the inflamed part. Now quinia has no effect of this kind. As already stated, it has tendency rather to increase than to diminish the proportion of fibrin in the blood, the augmentation of which is one of the characteristics of severe inflammation. It is true that, except in the phlegmasia of the brain, and the alimentary mucous membrane, and probably the urinary passages, it has little if any direct effect in increasing inflammation; and the existence, therefore, of this condition does not positively forbid the use of quinia when decidedly indicated on other grounds; but, in simple inflammation in its active stage, there is no sufficient ground for its use; and, in the large quantities which would be required to suppress the febrile phenomena, it might in various ways do harm.

But there are states of inflammation in which it is highly useful. As before mentioned, it may be employed, often with the greatest benefit, in miasmatic intermittent and remittent fever complicated with this condition; acting as an antiperiodic in reference to the general disease, and relieving if not curing the local, by removing the injurious influence of the paroxysmal excitement upon it. Moreover, when inflammation is attended with a low, asthenic, or typhoid state of system, this medicine is highly useful as a tonic, aiding in the support of the system until the inflammation has run its course. Upon the same principle, it is useful in the suppurative or gangrenous state of inflammation; and, in these cases, has the additional advantage that, by its tonic powers, it assists in the repair of the local injuries inflicted by the disease, which might not be carried on to completion without this or equivalent aid.