86 THE TREATMENT OF DISEASES. 



Before we had quinine we used bark, and before bark camomile-flowers, and 

 calomel, and bleeding, and all kinds of tilings. Some years ago, a favourite remedy 

 for ague was a spider's web, and there are many people still living who will 

 remember having been given in their youthful days a great big black spider wrapped 

 up in a split raisin, for the cure of this complaint. It is quite possible that by 

 the powerful impression it made upon the mind, it may have been efficacious in 

 warding off an approaching fit. 



Nowadays we always give quinine ; always, that is to say, if we can get it, for on 

 foreign service it sometimes runs short. In the case of a first attack you will do 

 well to assume that the type is quotidian, that is, that the patient will have a fit 

 every day. You must manage to give thirty grains of quinine between the 

 termination of the first paroxysm and the time on the following day at which 

 the second may be expected. You must give the first dose of ten grains towards 

 the termination of the sweating stage, and you must give your last ten grains about 

 two hours before the next fit is due. The strong quinine mixture (Pr. 10) contains 

 five grains in the ounce, so that your dose of ten grains will be contained in two ounces 

 or four table- spoonfuls. Let us take an example. Suppose the first fit to begin at 

 ten o'clock in the morning. It will be almost sure to be over by eight in the 

 evening, or .perhaps earlier, and you must then give your first dose of four table- 

 spoonfuls of the strong quinine mixture. About one or two in the morning you will 

 give your second dose, and your third and last dose at eight o'clock. What else is 

 there to be done? If the bowels are confined you had better get them open by 

 a calomel pill (Pr. 61) given at bed-time, but this is of course not necessary in every 

 case. Some people strongly recommend the use of emetics in ague, but they are not 

 often required. If the tongue is very foul, or the stomach loaded with food, they may 

 be useful and you may give relief by an emetic dose of ipecacuanha wine ; but it should 

 be distinctly understood that such cases are exceptional. Sometimes the stomach is 

 so irritable that it won't retain anything, and the quinine is thrown up as soon as it 

 is taken. What is to be done in this case 1 The quinine must be given, and if the 

 stomach won't tolerate it, it must be administered by the bowel. There is not the 

 slightest difficulty in giving an injection, but if you don't understand how to do it 

 you had better get some one who does. The quinine mixture may be poured into 

 about a tea-cupful of beef-tea or gruel, and then injected. Don't use too much 

 fluid, for it will only be rejected, and the medicine wasted. If this treatment 

 doesn't succeed in arresting the progress of the complaint, you must wait patiently till 

 the next fit is over, and then try again. Should you, however, succeed in preventing 

 the recurrence of the fit, you may consider that you have done very well ; but for 

 all that your work is not yet over. The patient should take two table-spoonfuls of 

 the strong quinine mixture, in other words, five grains of quinine every four hours, 

 until he is pretty fully under the influence of the drug. When he tells you that he 

 has a ringing in the ears you will know that he is suffering from "quinism," 

 or " cinchonism," as it is called, and that he has had enough, and that you may 

 discontinue the drug, or at all events give a smaller dose less frequently. The 

 phenomena which constitute cinchonism will be described when we speak of quinine. 

 If the patient have no more fits you may consider that you have cured him ; but if 



