[Reprinted from the American Gynecological and Obstetrical Journal 
for March, 1895.] 
ACTION OF QUININE UPON THE INTERNAL GENITAL 
ORGANS DURING PREGNANCY AND 
MENSTRUATION.* 
By George Coromilas, M. D., Calamata, Greece. 
Corresponding Fellow of the Obstetrical and Gynaecological Society of Paris. 
Petitjean was the first who wrote in 1845 that he had so often 
seen abortion produced during the administration of quinine for in- 
termittent fever, and Rodriguez the first also who denied Petitjean's 
assertion. 
Ten years had passed (in 1855) when Dr. John S. Wilson de- 
scribed the uterine action produced by quinine ; in i860 Dr. J. H. 
Rich reported several cases of alarming uterine haemorrhage speedily 
checked by its means. General attention had not been attracted to 
this subject until the appearance of an elaborate article by Monteverdi 
(1871), who concluded that quinine might be given with prudence to 
pregnant women, and that it is a trustworthy ecbolic and preferable 
to ergot. This paper provoked expressions of opinion from physicians 
everywhere, especially from those who practiced in malarious districts. 
They divided into two parties : those who received the opinion of 
Petitjean, Wilson, Rich, Monteverdi, and those who absolutely denied 
that quinine has the property of stimulating uterine muscular fibers- 
viz., the adherents of Rodriguez' opinion. As neither party has per- 
suaded the other, there still exists a doubt in regard to this action of 
quinine. 
For this one reason I dared to present before the London Obstet- 
rical Society an account of three cases-all I could collect in my own 
country-and a fourth in which the quinine produced haemorrhage, 
hoping thereby that the Fellows of this Society may have their atten- 
tion attracted to this subject. 
Before entering into the details of my observations, let me say that 
the most part of the inhabitants of Tergestures-Messina and Laconia 
* Read before the Philadelphia Obstetrical Society, February 7, 1895. 
Copyright, 1895, by J. D. Emmet and A. H. Buckmaster. George Coromilas, M. D. 
2 
-have an intense prejudice against the use of quinine during preg- 
nancy and menstruation. 
Case I.-Mrs. V., of Tylos, thirty years old, multipara, was eight 
months pregnant. 
December, 1888, she came to consult me, telling me that she had 
intermittent fever a long time ago. 
Present State.-Delicate, anaemic, nervous ; liver a little hyper- 
aemic, spleen hypertrophic, tongue a little saburral. I determined the 
diagnosis of an intermittent fever and gave twenty-four grains of va- 
lerianate of quinine in ten doses ; ordered her to take one every half 
hour. 
After the third dose I renewed my visit and I found the patient 
having pains in the renal and hypogastric regions and all the symp- 
toms of a labor. I prescribed some narcotics, but the patient changed 
doctors and I could not learn the result. 
Case II.-Widow G., of Calamata, Greece ; aged thirty years ; was 
six months pregnant from a clandestine marriage ; multipara, delicate, 
nervous. She had no other abortion nor premature accouchement 
while living with her husband. She used all empirical means possible 
to provoke an abortion but all was ineffective. 
February, 1894.-They called me to see her, whom I found was 
attacked by influenza. It was accompanied by double broncho-pneu- 
monia. I cured the patient in fifteen days without ordering quinine ; 
when she was convalescent I took occasion to prescribe salicylate of 
quinine. 
20th.-I prescribed twenty-four grains of salicylate of quinine in 
ten packets, to take one every hour. After the third dose I returned 
and I found the patient was in labor, the pains being regular and 
seemingly natural. I desired to supplement the other medicines and 
ordered opium or morphine, but without effect; she desired the pre- 
mature accouchement and hid the remaining packets of quinine, in 
order to take them if the premature accouchement did not take place 
with the first three. 
215/.-The patient was delivered last night. 
Case III.-Mrs. A., of Calamata, Greece; aged twenty-five; had 
had two children at full term. 
They called me to her and said that the patient was delicate, nerv- 
ous, having no special predisposition to abortion nor premature ac- 
couchement. 
April 8, 1894.-She was pregnant four months for the third 
time. Action of Quinine upon the Internal Genital Organs. 
3 
There was slight pyrexia, but no physical signs of disease were 
detected. 
()th.-Early in the morning she took twenty grains of sulphate of 
quinine, in one hour. After the last dose she felt hard pains which 
produced the abortion. 
I have very often administered eight grains of quinine to preg- 
nant women, in three packets, with the recommendation to take one 
every half hour, or every hour, and if they feel a pain after the first 
or second dose not to take the others ; otherwise to take all. Some 
pregnant women have felt nothing and I increased the dose the next 
day ; others who have felt pains I have cured with other antipyretics 
and antiseptics. 
Also I observed, in the administration of quinine during the men- 
struation, sometimes the stoppage of the blood and very often its 
diminution. 
Conclusion. 
From my experience till now I conclude that quinine has a certain 
oxytoxic action, produced by uterine contraction. 
That the women who are anaemic, nervous and debilitated have a 
predisposition more than others. 
We should never prescribe quinine during pregnancy and men- 
struation, in large doses, without associating it with one or other nar- 
cotic medicine unless there exist an evident contra-indication, or 
when we do not know the predisposition. 
Case IV.- Miss EL, Sp., of Arcoch, Calamata, Greece; twenty- 
three years of age, having had her menstruation regularly till April, 
i893. 
Five years ago she suffered with haemoglobinuria (from quinine) 
and since then had not taken quinine. 
One of her uncles died in 1893 of haemoglobinuria from quinine. 
April, 1893.-Dr. Oconomopoulos had prescribed for her some 
pills of iron and quinine. She used them a few days after her last 
menstruation and the flow came back, whitish, irregular, with pains in 
the renal and hypogastric regions, and lasted twelve days. It was the 
first time she had those symptoms. Six days after this haemorrhage 
stopped, she began again to take the same pills, and the flow returned. 
Therefore her parents called Dr. Alvanakes, who does not believe 
that quinine has an action on the uterus, and prescribed a bitter drug 
which increased the pains and haemorrhage. Changed this doctor 
and called me when I found the patient in the following state : 4 
George Coromilas, M. D. 
Pale, debilitated, anaemic, pulse slow, strong pains in renal and 
hypogastric regions ; the percussion in the hypogastric region reveals 
an insignificant dullness ; and I observed an alarming uterine haemor- 
rhage that was checked by using antipyrine, four grammes in one 
day. 
Afterward, for three months, her menstruation came back every 
twenty-seven to twenty-nine days, abundant, with six to seven days' 
duration, and later, till April 8, 1894, was very regular in quantity, 
quality and duration. 
April 8, 1894.-She had had her menstruation, when by order of 
her ordinary doctor she used cinchona wine. 
xltth.-Menstruation again with pains and duration till 22d. 
Stopped after abstention from cinchona wine. 
25th.-She called me in. By palpation and pressure she felt a 
little pain in the left ovary's region. 
26th.-I ordered citrate of iron, 2 grammes ; sulphate of quinine, 
1 gramme ; water, 100 grammes ; to take every day two or three tea- 
spoonfuls, viz. one after each meal, in old brandy or in wine. 
27th, A. M.-I asked if she took it and she answered me that she 
was afraid to drink this medicine ; on my recommendation she de- 
cided to take a teaspoonful after dinner and another after supper. 
28//$, A. M.-A teaspoonful after breakfast and another after 
dinner. 
P. M.-She feels pain in renal and hypogastric regions. I 
stopped it. 
29//Z, A. M.-A teaspoonful after breakfast and another after 
dinner. 
30///, A. M.-A teaspoonful after breakfast and after dinner and 
a tablespoonful after supper. 
May \st.-She feels strong pains. I stopped it. 
3//.-I make her drink again some teaspoonfuls. 
4th.-She departed for the country with the recommendation to 
take this medicine ; a teaspoonful after breakfast and after dinner 
and a tablespoonful after supper. 
6th.-I received this letter : 
" Sir : I have promised you to take account of every symptom 
which I could observe ; according to my promise, I tell you that the 
day following my arrival here, my menstruation came back with so 
much pain that I could not find relief." 
I then prescribed antipyrine three grammes in ten packets, with Action of Quinine upon the Internal Genital Organs. 
5 
the order to take each, the first five every half hour, and the others 
every hour, and to stop all other medicine. 
Second Letter, May 7 th, Morning. 
" When I began to take the packets which you sent me yesterday 
the haemorrhage diminished sensibly, but the pains are nearly the 
same." 
3 P. M.-A man told me that the patient having need to go to 
the water-closet, the haemorrhage recurred and she fell to the ground 
from dizziness. 
I prescribed ergotin, ether, cognac. 
8//z.-I received this letter : 
" It is the fourth day to-day and the haemorrhage exists yet, but 
very little." 
10th.-The flow stopped. 
August 22d.-She came to see me and said : 
"A month ago my country doctor prescribed a little dose of qui- 
nine, and I took half; after one hour I felt renal and hypogastric 
pains, after two hours I saw some drops of blood on my drawers, 
and my urine became a little dark." 
She complains of a little pain in the renal region ; examining the 
hypogastrium by palpation and pressure I can not find any lesion. 
I administer sulphate of quinine 0.40 in three packets, to take one 
every half hour. 
P. M.-More renal pain than in the morning. 
They permitted me, for the first time, to examine the vagina, with 
my little finger. 
Hymen intact, I felt external os uteri pointed and no other lesion. 
2igi.-She is better, saw some drops of blood on her drawers. It is 
fifteen days since she has had her menstruation. They do not permit 
me to examine thoroughly for the second time, by vagina, to affirm if 
some lesions exist or not in the uterus.