1 200 



THE MALARIAL FEVERS 



solved in acidulated water. It has not such deleterious effects on the stomach 

 and nervous system. 



Another remedy which contains quinine sulphate, and which was much 

 vaunted in days gone by, is Warburg's tincture, which is said to be prepared 

 by macerating for seven days the following ingredients — 



Grains. 



Aloes socotrinse . . . . . . . , , . 240 



Rhei , . 80 



Fructi archangehcae of&cinalis . . . . . . 80 



Radicis inulse helenii . . . . . . . . 40 



Croci . . . . . . . . . . . . . . 40 



Fructi foenicali . . . . . . , . , . 40 



Cretse preparatse . . . . , . , . . . 40 



Radicis gentianae . . . . . . . . . . 20 



Radicis curcumae zedoariae . . . . . . . 20 



Cubebae . . . . . . . . . . . . 20 



Myrrhae . . . . . . . . . . , . 20 



Polypori officinalis . . . . . . . . . . 20 



Opii . . . w . . . . . . . . . . 2^ 



Piperis nigrae . . . . . . . . . . 4 



Cinnamonis . . . . . . . . . . . . 3 



Zingiberis . . . , . . . . . . . . 8 



in a pint of 60 per cent, alcohol for a week; then pressing, filtering, and dis- 

 solving in the filtrate : — 



Grains. 



Quininae sulphatis . . . . . . . . . . ■ 175 



Camphoris . . . . . . . . . . . . 20 



and after three days' filtering, making up to the pint with alcohol. The dose 

 of this mixture is i to 4 drachms. 



Other preparations can hardly be said to have any particular interest. 



In order, however, to bring these various preparations into line with one 

 another, it is necessary to have some arbitrary standard, and this is generally 

 taken as quinine sulphate, which is reckoned as equal to i . The hydrochloride 

 will then be 0*9, the bisulphate 1*24, the bihydrochloride i'02, the bihydro- 

 bromide 1*23, the valerianate i-oi, the tannate 3*67, euquinine i*o, and 

 Warburg's tincture i-og 



New Salts of Quinine. — Dihydroquinine hydrochloride (o*6 gramme =i*o 

 gramme quinine hydrochloride) is said to be have a specific antimalarial action, 

 but aurochin, chitenin, and tetrahydro-quinine are not satisfactory. 



Cinchonin Salts. — Various cinchonin salts have been used in the treatment 

 of malaria, and Sir Leonard Rogers has recently recommended intramuscular 

 injections of cinchonin bihydrochloride. 



Effects on Man. — When taken by the mouth, quinine should be dissolved 

 in the acid gastric juice, converted into the bihydrochloride, and absorbed 

 completely into the blood from the stomach, especially if food is taken at the 

 same time. If this does not happen, then such a salt as the sulphate may not 

 be absorbed at all, as it will be precipitated in the alkaline intestinal contents. 

 When given in large or frequent doses, it is apt to irritate the stomach. As 

 to what happens to it in the blood, there are two distinct views — one pointing 

 to rapid elimination, and the other to the fact that it undergoes changes in 

 the tissues. It would appear to be retained longer in the body if absorbed 

 together with food. 



It can also be administered by intramuscular injections, when it is said to be 

 largely precipitated at the site of the injection. We have no knowledge 

 personally of this precipitation, and our experience is that intramuscular 

 injections have been most satisfactory, though it must be admitted that there 

 are observers who think that administration per os is more valuable than that 

 by intramuscular injections. It may also be given intravenously, as will be 

 explained later. 



Quinine in small doses is a vascular tonic, but in large doses it is a cardiac 



