In the continued or remittent restivo autumnal fevers the patient is person ally put on the following, prescription. It must be compounded exactly as writ ten and not filtered. When properly made, it looks like buttermilk, and must be shaken each time before using: 3lagnesium sulphate, 1/,,. ounce. Solution of ammonium acetate, 1 ounce.
Quinine sulphate. 4 grains. Camphor-water, enough to make 11 ounces.
31. Sig.: T1N-0 tablespoonfuls every four hours, fever or no fever.
This pres'eription g.00d in any form of acute malarial disease, but is pre ferred in eases in which the fever is con tinued or in which the patient cannot take full doses of quinine, on account of head symptoms. It produces a gentle perspiration, keeps the bowels open, re duces the fever, and nearly always af fects a cure. AV. P. McIntosh (New York Med. Jultr.. NON% 30. 1901).
When administered hypodermically the neutral hydrochlorate of quinine is to be preferred on account of its greater solubility, 1 part being soluble in 0.66 parts of water. The following solution is recommended by de Beurmann and Villejean for this purpose: 11j, Quinine dihydrochlorate, 75 grains. Distilled water, enough to make 2 1/2 drachms.-11.
One cubic centimetre (15 minims) of this solution represents 0.50 (S grains) of quinine dihydrochlorate. (Laveran.) The intravenous injection of quinine has been advocated by Baccelli, but, as pointed out by Laveran, it should not be resorted to "except in the very severe pernicious paroxysms and when there is reason to fear that even the hypodermic method will not effect a sufficiently rapid introduction of the salts of quinine into the blood." Baccelli recommends the following solution: 1)), Quinine hydrochlorate, 15 grains.
Sodium chloride, 12 grains. Distilled water, 2 fluidounces.
M.
This solution is, of course, to be in jected warm.
For certain pernicious forms of malaria the intravenous injection of a neutral salt of quinine should be given : 13 Quinine hydrochloratis, 15 grains: Sodii chloridi, 1 grain.
Aqum destill., 2 V, drachins.M.
This may be injected into the VeillS in progressively diminishing doses. Bac (mill (Wiener med. \Voch., Jan. 11, '90).
The treatment of chronic malarial fever by subcutaneous injections of qui nine bihydrobromate is of remarkable efficacy. It is not very painful if the bihydrobromate salt is used. The billy drobroma te is perfectly stable, and makes a solution (1 in 6) that is only faintly acid. The method personally followed is to inject subcutaneously 3 grains (0.20 gramme) of quinine billy drobromate dissolved in 20 minims (1'1/3 cubic centimetres) of pure warm water.
It is first injected under the skin of thc upper arm, then under that of the thighs, then under the skin of the abdo men, or at the top of the chest or be tween the scapulm. Six injections on alternate days are usually required in a serious case, and 3 grains under the skin will prove much less distressing and more curative than 30 by the mouth. A syringe should be kept for the purpose. and should_ be used for nothing else. The syringe and the patient's skin are disinfected with strong carbolic lotion and also the physician's hands. The needle is sterilized in the flame of a spirit-lamp. The solution of quinine is sterilized when first made, and may be boiled each time before using. The dose of 3 grains may be exceeded on special occasions or it may be given several times a day, lint it will usually be suf ficient.
The excretion of quinine through the kidneys begins a, few minutes after a dose has been given, and it is this fact that explains' the superior results from its subcutaneous uie. Slowly absorbed through disordered stomach and in testinal membranes, it is excreted nearly as fast as it is absorbed, and never reaches in the blood the strength suf ficient to destroy the malarial plasmo dia,. Quinine subcutaneously affects the head less also. It is advisable to give the injections two or three hours before the expected paroxy-sm, though in chronic cases it does not seem to matter much when one injects, provided that it is done often enough. (1. 13. Ferguson (Brit. Med. Jour., Fel). 22, 1902).
The administration of quinine should be so timed that the maximum influence of the drug shall be obtained at the time of the sporulation of the parasites, for the reason, as has just been said, that it exerts but little toxic influence upon the parasites as long as they remain within the blood-corpuscles. The drug is given, therefore, not with the hope of averting the pending paroxysm, but with the purpose of destroying the free young segments upon which the succeed I thptml. In the f t revtilarly intermittent t 1?.'? Obit t IS re:hlily accom - ...I. al, 1 CII S111011 (loses of the drug frt 1.11tIV 111'0\ t quite t-titlicient. It er. to vary the dose some in neeordante with the severity of ii in this type of fever; so h., t in the milder eases 2 grains . It Ft 111111.:- daily will prove ef (I I t ill rtaking up the paroxysms, in ri.t of a somewhat more severe in :, ti- n it may be well to give 5 grains oirt- tiims daily. It is at times ad in this latter class of cases to u-N.- larze dose of quinine at the ex ' ttd time of the paroxysm, and, after 1_ thus for several days prevented .-s o cum nee, to continue the use of the dru- in small doses three times daily for v. ral wteks. It is claimed by Laveran that the tYpe of fever should not cause r. V very marked variation in the manner of the administration of quinine, either rt-zards the dosage or the time of tak .ng. Thus. for a male adult he advises tl fdlowing practical directions: 'On :Le 1st. 2d, and 3d days from SO centi gramme, to 1 gramme (12 to 15 grains) cf qihnine hydrochlorate daily in the r-e cf twenty-four hours; on the 4th, cth, and Tth days no quinine; on tl.e sth, 9th, and 10th days from GO to i centigrammes (9 to 12 grains) of hydroehlorate: from the llth to tl e 14th day no quinine; on the 15th ari 1 1Gth days. fre.m GO to SO centi gran toes (9 to 12 grains) of quinine hv dre.h1-rate: frern the 1Tth to the 2.0th day- no quinine; on the 21st and 22d d-yz from CO to SO centigrammes (9 to 12 grans) of quinine hvdrochlorate." Segm,,ntation occurs at or about the cd the paroxysm: hence the quinine ,hould be given shortly before it in order that it may be in solution in the blood hen segmentation takes place. In this ay a group of organisms may be almost entirely destroyed by a single dose. It is advisable to give a second dose just be fore the time at which the next paroxysm would occur. Fifteen or 20 grains may be given for the first dose and 10 grains for the second. J. L. Morse (Boston Med. and Surg. Jour., Jan. 16, '96).