The number of quinin salts manufactured and put on the market is very large. In the last edition of Ewald's "Handbuch der Arznei verordnungslehre" (thirteenth edition, 1898) I counted, apart from quinin, not fewer than 33 quinin salts. That the great majority of these are superfluous scarcely needs mention.

The Austrian Pharmacopoeia of the year 1889 gave the following preparations as official: Quinin bisulphate, ferrocitrate, hydro chlorate, sulphate, and tannate. The German Pharmacopoeia considers official quinin ferrocitrate, hydrochlorate, sulphate, and tannate.

Among these preparations the hydrochlorate and bisulphate deserve the preference. Both are readily soluble (the first in 34, the second in 11, parts of water), and both contain relatively large amounts of the active principle. The first has this advantage over the second that its watery solutions are less inclined to become moldy.

The quinin may be introduced into the organism per os, per rectum, endermatically, subcutaneously, and intravenously.*

Each of these methods of administration, omitting the ender matic one, which was abandoned as useless, has its indication. The common method of administration is per os. It is to be preferred in mild cases of intermittent, remittent, or subcontinued fever as long as an uncontrollable vomiting does not render it futile, and as long as pernicious symptoms do not demand the more rapidly acting subcutaneous injection. Quinin is administered per os in solution, powders, pills, and tablets. The solution has the undoubted advantage of being more quickly absorbed, thereby producing a more marked effect. In armies it has been generally employed with good results. The patient should be compelled to swallow the solution in the presence of the physician, in order to prevent deception. As a corrigent, a piece of lemon peel may be employed.

* As a matter of curiosity, we may mention that even up to the beginning of this century Peruvian bark was employed as an addition to baths, as well as sometimes "sewed between two shirts" (Reil).

The repulsive bitter taste has succeeded, however, in spreading the employment in powder form in civil practice. Pills, pralines, and tablets are inadvisable, on accomit of their possible insolubility, though they must occasionally be employed in the case of sensitive people and children.

As tasty corrigents may be recommended syrup, liquiritise, coffee with cognac, different fruit juices, and milk. For children between four and six years Crequy recommends:

Quinin. muriat.............................. 0.30

Syr. liquiritiae.............................. 3.00

Aquae......................................40.00

Some persons experience a burning in the stomach after taking quinin. In such cases Liegeois recommends its administration with equal parts of antipyrin.

Per rectum* the drug is exhibited in lukewarm clysters to which several drops of the tincture of opium may be added to aid retention. A cleansing injection must be given previously.

The endermatic method, as mentioned previously, has been entirely abandoned. Only minimum quantities of the drug penetrate the intact skin, and its application to places where the epidermis has been removed by vesicants is both painful and uncertain.

The subcutaneous or intramuscular injection of quinin is, on the contrary, of special importance. It is indicated in all cases in which severe symptoms demand prompt interference. It is, therefore, employed considerably in malarial regions, and has proved itself of inestimable value in pernicious malaria .

The injections must naturally be made under special precautions, otherwise inflammation, abscess, or phlegmon may result. In warm countries even tetanus has been observed to follow the injections (Vincent and Burot). It is consequently necessary to disinfect the skin by washing it with soap and water, alcohol, and bichlorid of mercury. The syringe should be made entirely of glass, with a needle of platin iridium. Before employment it should be boiled and the needle heated to a red heat. The injection may be made either subcutaneously or into the muscles, preferably those of the gluteal region. No matter what solution is used, the injection is always more or less painful.

* According to Torti, Hadrianus Helvetius was the first to recommend the administration per rectum. Torti himself used this method in severe infections. We may prescribe, for instance:

Quinin. hydrochlor......................... 1.0

Aquae...................................200.0

Tr. opii spl...............................10 drops

Sig.-Two clysters.

Quinin. hydrochlor......................... 1.5

Butyri cacao, q. s. ut ft. suppositoria No. 5. Sig .-Suppositories.

The solution should be sterilized. If crystals precipitate, they should be dissolved by renewed warming. The most commonly employed salt is quinin bimuriate. It is best to have at hand sterilized solutions of this in a proportion of 1: 2 in glass vials, each serving for one injection* In other cases the following solution may be prepared :

Quinin. bimuriat.......................... 5.0 grams.

Aquae dest. et sterilisat.....................10.0 c.c.

One injection of 1 c.c. contains 0.5 quinin.

According to Beurmann and Villejean, in the absence of quinin bimuriate it may be readily prepared from quinin muriate by adding to the latter an equal quantity by weight of hydrochloric acid (D = 1045),**and to the solution obtained, an equal quantity of water. This makes a solution which contains 0.5 quinin bimuriate in every 1 c.c.

Injections of quinin bihydrochlorate are almost painless. The same is also said of quinin bihydrobromate. Solutions of this latter 1 to 3 to 10 of water are injected warm.

Von Stoffella dissolves, under light warming, 2.0 quinin muriate in 10 c.c. distilled water, and injects the solution lukewarm. He claims that the injection is painless.

La Bord and Grimmaux recommend:

Quinin. hydrochlorico sulph................ 5.0 grams

Aquae dest................................10.0 c.c.

M. D. S. injection.

1 c.c. =0.5 of the drug.

* These vials may be procured, among other places, in the Kade'schen Oranien-Apotheke in Berlin (Plehn).

** Official hydrochloric acid is diluted with distilled water until the aerometer shows a specific gravity of 1045. Then, for instance, 5 gm. quinin muriate is dissolved in as much of the acid as will eventually make 5 c.c.

Kobner recommends:

Quinin. hydrochlor.........................0.15-0.25 gram

Glycerini puri

Aquae................................aa 0.5 c.c.

Disp. sine acido, to be injected lukewarm.

Triulzi recommends a combination of antipyrin and quinin. This gives less pain and the quinin is made more soluble:

R,. Quinin. muriat............................3.0

Antipyrin................................2.0

Aquae...................................6.0

M. D. S. injection.

1 c.c. =0.30 of the salt.

Vincent and Burot employ with success the following formulse:

1$. Quinin. muriat............................3.0

Analgesin................................2.0

Aquae.............'......................6.0

1 c.c. = 0.5 quinin.

1$. Quinin. muriat............................10.0

Aquae dest................................ 7.5

Acid. mur. dil............................. 2.5

M. D. S. injection.

1 c.c. =0.73 of the salt.

Burdel recommends the injection of quinin in alcoholic or, better, ethereal solution. He claims that absorption is more rapid than in the watery solution.

The other preparations, especially quinin sulphate, are not suitable for injection.

Intravenous injections were introduced by Baccelli. He considers them indicated in very serious pernicious cases, especially the algid (in which the power of absorption is very low) and comatose.

The needle is introduced, naturally under the strictest antiseptic precautions, directly through the skin into a vein of the arm, distended by a tourniquet. The compression is then removed and the drug slowly injected.

Baccelli employed for intravenous injection the following solution:

Quinin. muriat............................ 1.000

Natr. chlorat.............................. 0.075

Aquae dest................................10.000

M. D. S. injection.

Before using, the solution is filtered and boiled.

One or more injections of ether are administered at the same time as an analeptic. Baccelli, who usually injects 1 gm. of quinin at a dose, never observed any unusual result.

It is worth noting that on intravenous injection of 1 gm. of quinin the blood is made to contain the amount (1: 5000) which according to Binz, rapidly produced death in infusoria. Baccelli claims that the severe symptoms rapidly yield to this method of administration.