Dose.—The dose of Sulphate of Quinine will vary according to the condition of the patient and the effect desired. For its stimulant and tonic action the dose will be from one-half to two grains; as an antiperiodic the quantity given during the intermission will be from ten to twenty grains. In proportioning the dose for children, it is well to add one grain for each year, starting with the quantity of one grain for a child one year old.
Specific Indications.—The indication for Quinine is periodicity, and the fevers take the form of remittent and intermittent. In some cases the periodicity is so marked that the observer can make no mistake, but in others it is very obscure, and practitioners to be successful need to be close observers.
Quinine will act kindly if the pulse is soft, the skin is soft, the tongue moist, and the nervous system moderately free from irritation. It does not act kindly when the pulse is frequent and hard, the skin dry, the tongue dry, and the nervous system excited.
These being facts, it becomes necessary, in many cases where quinine is indicated to prepare the patient for its use. This preparatory treatment lessens the frequency of the pulse, reduces the temperature, softens the skin, and relieves irritation of the nervous system. Now the remedy acts kindly and is curative, where it would have caused unpleasant excitement, and probably increased the disease.
Therapeutic Action.—Sulphate of quinine is tonic and antiperiodic when administered in medicinal doses, and posesses the properties of the cinchona. In large doses it has been observed to occasion severe headache, vertigo, deafness, tinnitus aurium, diminution or loss of sight, dilated or contracted pupils, loss of speech, general trembling, intoxication or delirium, coma and great prostration. These unpleasant effects, following the too free use of the agent, arise, probably, from the exhaustion consequent upon the undue excitement occasioned by the over-dose of the medicine.
The rule we act upon in its administration is this: Whenever an acute disease exhibits periodicity, we administer the agent during the intermission, or when there in the least excitement of the circulation; but if this can not be done, owing to the shortness of the intermission, we give it during the reaction. We have practised upon this plan sufficiently long, we think, to have discovered any injury that might result, but have never seen any. Thus in bilious remittent fever, when the remissions are but half an hour or an hour, there not being sufficient time for the administration of the necessary amount of the remedy, we continue it during the exacerbation, and we have almost invariably found that, instead of increasing the fever, it shortens its duration, the next remission being longer and more complete. In fevers, however, in which there is no symptom of periodicity, we never employ it except as a tonic to prevent prostration.
In the advanced stages of continued fever, when there is great prostration of the vital powers, the importance of this agent is not to be overlooked. In all adynamic fevers and diseases characterized by atony and debility, in cachexia of a scrofulous character, in mercurial and syphilitic cachexia, when the vital energies are greatly impaired, in cases of gangrene or mortification, in passive hemorrhages and profuse mucous discharges, in short, in all cases requiring an energetic and sustaining course of medication, the sulphate of quinine will be found an important agent.
We find, sometimes, that owing to the irritability of the stomach, or repugnance to the taste of this agent, it can not be administered, at least in sufficient quantity to effect the desired result. In such cases we employ it endermically, directing one drachm to be rubbed up with two drachms of lard, and freely rubbed into the axilla, groin, and if necessary the inside of the thighs. We have been enabled, in many cases to control an intermittent or remittent fever in this way, when all other means had failed; it is particularly applicable to females of a debilitated and nervous habit, and in treating periodic diseases of children. Quinine has also been employed with success as an enema; to an ounce of starch add twenty grains of quinine and thirty drops of laudanum; it should be used three or four hours previous to the expected recurrence of the paroxysm.