556 THE TREATMENT OF DISEASES. 



Cold packs are sometimes substituted for baths, and they are nearly always 

 used in the case of children. A course of four consecutive packs of from ten to 

 twenty minutes' duration apiece is about equivalent in effect to a cold bath of ten 

 minutes. 



Quinine is a drug which is very commonly used for reducing the temperature 

 in typhoid fever. It does very little good when administered in ordinary five- 

 grain doses. From twenty to forty grains must be given to produce any very 

 marked effects. This quantity must positively be taken within the space of half 

 an hour, or at the most an hour. The sulphate of quinine must be administered 

 in powder in seven-grain doses every ten minutes. It is useless to expect much 

 benefit if the dose is divided and the administration extended over a long period. 



Liebermeister, of whom we have already spoken as an authority on typhoid fever, 



" There are still a good many physicians who have a sort of dread of these large 

 doses of quinine. Where a dose of thirty grains is indicated, they give fifteen, and 

 then try to make up the deficiency by repeating it oftener, say every day or twice a 

 day. No sufficient and satisfactory result need be looked for from such a method. 

 I have given quinine in large doses to at least 1,500 typhoid fever patients, besides 

 hundreds of patients with pneumonia and other diseases. The number of single 

 doses, of one scruple (twenty grains) to forty-five grains, which I have ordered in 

 hospital and private practice, probably amounts to 10,000. And in no single 

 instance have I seen any permanent injury follow which I could attribute to the 

 action of the quinine." 



These full doses of quinine usually produce a loud ringing or roaring in the ears, 

 and partial deafness. In rare cases they may even bring about a state similar to 

 that of drunkenness, with unsteadiness of motion, weakness in the legs, and a 

 decided feeling of discomfort. The temperature of the body falls materially;, some- 

 times even to the normal standard, and soon all the symptoms dependent on the ex- 

 cessive fever are modified. The decline of temperature usually begins in a few 

 hours after taking the medicine, and reaches its maximum in from six to twelve 

 hours after. The first administration of forty grains within the hour should be made 

 in the evening, so that its effects may coincide with the natural daily variation in 

 temperature. It should never be repeated within twenty-four hours, and, as a rule, 

 it should riot be given again under two days. Quinine proves as successful in chil- 

 dren as in adults. For children under two years old, ten to fifteen grains are 

 required ; for those between the ages of three and five, fifteen grains ; for those 

 between six and ten years of age, fifteen to twenty-three grains ; and for those 

 between eleven and fifteen, twenty-three to thirty-one grains. The use of quinine 

 may be advantageously combined with the cold water treatment. 



Sometimes large doses of digitalis are used for the reduction of the temperature, 

 but this method of treatment is not altogether free from clanger. 



We must now pass on to the consideration of other symptoms which may require 

 treatment. If the bowels remain obstinately confined, a small dose of castor oil 

 may be given. Of course, constipation is an exception, and there is usually diar- 

 rhoea. If the purging is moderate, it requires no treatment. Should there be more 



