of the following solution: Hydrochloride of quinine 1 grm., sodium chloride 75 eg., distilled water 10 grm. This solution he has employed in these desperate cases with much success, injecting directly into a vein 5 to 7 grm. at a time. He states that whereas with hypodermic injection the mortality in such cases amounted to 17 per cent., with intravenous injection it was reduced to 6 per cent. Wright recommends for intravenous injection doses of 15 gr. in 250 to 300 c.c. of normal saline, to be repeated once or twice if necessary. The intravenous injection of quinine is now regarded by many British practitioners of tropical experience as the most appropriate and efficient treatment in all pernicious comatose and hyperpyrexial attacks. Bass, speaking from large experience, remarks that it is never necessary to give more than 30 gr. in twenty-four hours and never more than 10 gr. at one time. Large doses are dangerous.
Warburg's tincture.—— A very effective medium for giving quinine, and one of high repute in many places, is Warburg's tincture. This contains, besides quinine, a number of drugs, many of them doubtless inert, although some of them certainly possess valuable therapeutic properties. Experience has shown that the combination is really a good one, and that Warburg's tincture sometimes succeeds where quinine alone fails, or acts too slowly. It generally proves a powerful sudorific. The dose is ½ oz., and is repeated after two or three hours. The action appears to be somewhat similar to that of the antipyretics now in vogue—— antipyrin, phenacetin, etc.—— drugs which, when given in combination with quinine in the routine treatment of malarial fevers, although they have no curative properties, sometimes contribute very markedly to the relief of headache and febrile distress. They must be used with great caution in adynamic cases. At the present time these drugs are much abused in many malarial countries.
Mode of action of quinine.—— In what way quinine acts has not yet been satisfactorily explained.
