19

to a catarrhal condition or chronic venous congestion of the gastro-intestinal
tract and liver.

        3. Affections of the liver.—The probable adjuvant action of bile in Quinine
absorption has already been discussed. Carrive²⁶ has reported a case of hepatic
insufficiency in malaria (diagnosed by blood examination), and supposed to be
due to malaria, in which there was complete cessation of bile secretion and
diminished liver dulness. Under such circumstances Quinine by the mouth
would probably have very little therapeutic effect.

        4. The solubility of the Quinine salt employed.—Mariani,¹³ who has made a
thorough investigation of the effects on elimination of Quinine of the solubility
of the salt administered and of the food contents of the gastro-intestinal tract,
came to the conclusions that the total Quinine elimination is greater after
administering insoluble than after administering easily soluble salts; and that the
total Quinine elimination is also greater when Quinine is administered with a
meal than when fasting. Giemsa and Schaumann,⁵ using Quinine hydrochloride
and Quinine alkaloid, likewise conclude from the urine analyses that the less
soluble preparations of Quinine are at least as energetically absorbed from the
gastro-intestinal tract as are Quinine salts easily soluble in water.

        As it seemed reasonable to doubt the validity of inferring more energetic
absorption from the fact of the total Quinine elimination being greater, I
determined the minimum-lethal dose of Quinine bi-hydrochloride for guinea-
pigs (1) after fasting 24 hours and (2) immediately after food.

Table V.

MINIMUM-LETHAL DOSE OF QUININE BI-HYDROCHLORIDE FOR GUINEA-PIGS
BY ORAL ADMINISTRATION.

A.—After fasting 24 hours.

E