iigo 



THE MALARIAL FEVERS 



In order to combat severe symptoms, it may be necessary to 

 give 45-60 grains of quinine, or even more, per diem, but this must 

 be done carefully, and the dosage must at once be reduced when 

 improvement appears. As a rule, not less than 30 grains in the 

 twenty-four hours should be given. 



Quinine often takes effect before the expiration of four days of 

 thorough treatment, but it may be necessary to continue the ad- 

 ministration of large daily doses longer than this period. If quinine 

 appears to be ineffectual in checking the symptoms, care must be 

 taken to exclude any other possible cause for the symptoms. 



C. When the Acute Attack has Subsided. 



Continue to administer quinine orally for at least three months. 



During the first month give it in 10 grain doses twice or thrice 

 daily. During the second month 5 grain doses thrice daily. During 

 the third month 5 grain doses twice daily. 



The quinine may be administered, as the bihydrochloride, in crushed tabloids, 

 but if it is desired to use the more insoluble salts (see the paragraphs on the 

 theoretical considerations lower down in this chapter) a mixture such as the 

 following may be given: — 



Quinine sulphate . . . . . . 10 grains. 



Dilute sulphuric acid . . . . 10 minims. ^ 



Syrup of orange . . . . . . i drachm. 



Distilled water . . . . , . i ounce. 



Euquinine may be substituted for quinine for the purposes described in this 

 paragraph, but must be given in slightly larger doses. 



With the commencement of convalescence it is useful to give 

 some tonic mixture such as: — 



Iron and quinine citrate . . . . 10 grains. 



Liquor strychninae hydrochloratis . . 3-5 minims. 



Syrup of orange , . . . . . i drachm. 



Distilled water .. ,. . . i ounce. 



This should be taken three times a day half an hour after meals. 

 See that the patient's bowels are kept regularly open every day. , 

 Notwithstanding all care and energetic quinine treatment, 



relapses are prone to occur some variable time after medication 



has ceased. 



D. Relapses. 



When relapses occur after thorough quinine treatment it is 

 advisable to combine with this drug arsenic and at times tartar 

 emetic and phosphorus. 



The following mixture introduced by Castellani indicates the line of medica- 

 tion suggested: — Quinine sulphate, 10 grains; dilute sulphuric acid, 10 minims; 

 tartar emetic, ^-^ grain; codein, ^-^ grain; syrup, i drachm; chloroform 

 water, to t ounce. 



Another formula used by Castellani is: Quin. hydr., gr. x. ; tartar emetic, 

 gr. I; liq. Fowleri, 11^1.; syr., 3ii.; aq. chlorof. ad §i. 



Two tablespoonfuls of this mixture may be taken, well diluted with water, 

 every four hours. 



