AGUE. 87 



he is not careful he will have a relapse. The most likely time for a relaps< 

 lunar month from the date of the first attack, and preparatory to this the system 

 should aLjain IK I brought under the influence of the quinine. An old West Indian, 

 who has suffered much from ague, informs us that the best way to take large doses 

 of quinine is in a cup of green tea. He says, too, that in the tropics you require 

 much more quinine to produce the constitutional effects of the drug than you do in 

 England 



But what is the patient to have in the way of diet all this time 1 Just at first 

 you must support his strength by milk, plenty of good strong beef-tea, and other similar 

 nutritious substances. An occasional glass of hock or champagne, or a little brandy 

 and soda, won't do him any harm ; but if you give him wine it must be good. You 

 can't expect to get cured of the ague on eighteen shilling claret. As soon as the fits 

 aiv subdued, the patient may have anything he likes to eat in moderation, and care 

 should be taken to see that his strength is supported. You can't fight a fever on 

 an empty stomach. 



And what about complications 1 Well, don't trouble veiy much about them, but 

 go on treating the ague. Cure the disease, and the concomitants will get well of 

 themselves. Don't be induced on any account to give up the quinine for the sake of 

 a cough-mixture or anything of that kind, or you will suffer for it. At the same 

 time, if any serious complication is suspected, you had better get in a doctor without 

 delay. If there is at any time much irritation of the bladder, a little bicarbonate of 

 soda may be given. 



What is to become of the patient when he gets well? Of course he must not stop 

 in the malarious district. A change of scene, nutritious diet, and plenty of exercise in 

 the open air, will usually soon make things all right again ; but if there is any return 

 of the symptoms, recourse must be had to the quinine in moderate doses. A couple of 

 table-spoonfuls of the tonic quinine mixture (Pr. 9) three times a day may be taken 

 with advantage. 



But suppose quinine fails to effect a cure 1 Such cases do undoubtedly 

 occur. The addition of ten minims of the tincture of gelseminum to each of the 

 three doses of quinine should then be tried. A combination of quinine and gel- 

 seminum will often prove successful when quinine alone has failed. There is no 

 doubt that even by itself gelseminum is a very valuable remedy for ague. 



The objection to quinine is that it is a little bit expensive for poor people. In 

 the French army they give arsenic because it is cheaper. As we have said before, 

 economy in medicine is only another name for reckless extravagance. Arsenic is a 

 good remedy for ague, although it is far inferior to quinine. We must say, however, 

 that it has sometimes succeeded where quinine has failed. Five drachms of the arsenic 

 mixture (Pr. 40) may be given three times a day. Sometimes it may be used as an 

 adjunct to quinine. Thus, when the complaint has been checked by quinine, the 

 cure may be conveniently completed or confirmed by a little arsenic. Or on the 

 other hand, when little benefit has been experienced from quinine, the arsenic may 

 stop the fits, and quinine may then serve to prevent their recurrence. 



Salicine, obtained from willow-bark, is sometimes used in the treatment of 

 ague, when from any reason quinine is not obtainable. Thirty grains dissolved in an 



