114. ANTIPYRETICS 



fluenced, though if applied locally it is an irritant and may cause 

 contraction. 



Peripheral Nerves. A slow prolonged anesthesia follows the 

 hypodei-mic injection of quinine and urea hydrochloride at the site 

 of injection. 



Respiratory System, Small doses have no influence upon res- 

 pirations, but large or toxic doses paralyze the respiratory center. 



Temperature. In health there is no effect upon the tempera- 

 ture but in febrile conditions it is an antipyretic. This action is 

 due almost entirely to diminished production of heat and, since it 

 lowers temperature after division of the spinal cord, it does not 

 exert this action through the heat regulating center. Its action as an 

 antipyretic can be further explained as due to: 



1. Antiseptic action. There is some belief that it overcomes the 

 infection which is the cause of the fever, and consequently the fever 

 is reduced. 



2. Lessened reflex excitability. 



3. Diminished oxidation. 



Uterus, It is believed by some to be an abortifacient although 

 there is little direct proof of this action. There are indications, 

 however, that it may be of some use in labor after this has started 

 but the contractions are not tetanic as in case of ergot and pituitary 

 extract. 



Kidneys, Metabolism, Elimination. Quinine lessens the se- 

 cretion of uric acid and to some extent that of urea. It is chiefly 

 eliminated by the kidneys but is more or less unabsorbed and passes 

 out with the feces. Slight amounts are also eliminated by the bile, 

 tears, saliva and milk. 



Upon the Plasmodium of Malaria. Quinine is a specific 



poison for this organism. 



Cinchonism. In man a condition is sometimes seen after re- 

 peated doses or large doses, which is known as cinchonism. This 

 is manifested by eruption of the skin, itching, disturbance of vision, 

 impairment of hearing and a sense of fullness of the head. It is 

 treated with potassium bromides or hydrobromic acid. 



Therapeutics. 



1. Locally. Quinine and urea hydrochloride in solution have 

 come into extensive use as a local anesthetic. Hertzler, Brewster 

 and Eogers consider it suitable for all operations in man that can 

 be done under cocaine. They use a 0.25 per cent, solution in normal 

 saline, and have determined that stronger solutions retard healing. 

 Some operators use solutions of 1 to 3 per cent. In order to lessen 

 the liability to shock in human work, Crile uses it in major opera- 

 tions, to anesthetize the field of operation before cutting, to cut off 

 all afferent impulses. The bisulphate of quinine has also been- used 

 as a local anesthetic. 



