196 ATKINSON. 



partum haemorrhage in 42 eases so treated. It also diminished the 

 lochial flow where it had been excessive in former labors, the change 

 being remarked upon by the patients; it consequently lessens the sever- 

 ity of the after pains. Cinchonism is very rarely observed as an effect 

 of large doses in parturient women. 



I have discussed this question of the supposed ecbolic physiological 

 action of quinine with several of the medical practitioners in Hongkong 

 and they agree with me that this action is very slight; some, in con- 

 currence with myself, doubt that it has any effect in this way, and T 

 am inclined to believe with Dr. Albert Smith that it acts more as a 

 general stimulant and promoter of vital energy and functional activity. 

 Of one thing I am convinced, and that is that when quinine is admin- 

 istered in malarial fever it expends its energy in killing the plasm odium 

 and does not produce any deleterious effects on the system. 



The large doses of quinine which are sometimes required seem ex- 

 traordinary, but these doses can be given with impunity in some of 

 those malignant cases of malarial fever which every physician who 

 practices in malarial countries has occasionally to deal with. 



Similarly, large doses of other drugs are sometimes necessary in 

 certain other diseases and are tolerated by the economy. I need only 

 instance mercury in the treatment of syphilis and arsenic in the treat- 

 ment of certain forms of anaemia. 



