This proper administration necessitates at the outset rest in bed,
and it also necessitates a continuance of the drug for a sufficient
length of time. For ordinary cases the best way is to give quinine by
the mouth, and here again it is best given in solution, though it can
be administered in solid form if the precautions above indicated are
duly observed. Various doses have been advocated, but probably the best
quantity to administer is 30 grains every twenty-four hours. This is
usually given in three doses of 10 grains each, but there would appear to
be an advantage in giving four doses instead of three, and Colonel James
advocates the following times for administration, _i.e._ 12 midnight, 6
a.m., 12 noon, 6 p.m. He does so, because such a method of administration
is likely to ensure that there shall be a sufficient concentration of
quinine in the blood at the time when the youngest forms of the parasite
are present. The patient should remain in bed, if possible, for ten
days, or, if this is impossible, for at least half that period; and it is
essential that the quinine should be given as soon as possible, and quite
irrespective of the stage of the attack or the height of the fever. If
its administration is followed by vomiting, give a small teaspoonful of
bicarbonate of soda in warm water. If this is rejected repeat the dose,
and then give some form of stomach sedative, such as bismuth, and dilute
hydrocyanic acid or 20 drops of chlorodyne. A mustard leaf applied to the
pit of the stomach is often helpful. Sometimes drop doses of tincture
of iodine, well diluted, will check these troublesome symptoms. Under
ordinary conditions this 30-grain quinine treatment should be steadily
continued for at least five days, but in troublesome cases it may be
necessary to carry on with it for as long as three weeks. Thereafter what
is called the “after treatment” is begun and must be continued for a
period of three months, in order to ensure, if possible, an eradication
of the infection.
There are several ways of carrying out this after treatment, but one of
the simplest and most effective is to administer 10 grains of quinine
every day, the dose being taken an hour or two before the time at which
the fever was apt to come on during the attack.
If, despite quinine treatment, relapses occur, the patient must go to
bed and be treated as for the first attack, and the after treatment must
again be carefully carried out.
Under certain conditions quinine has to be injected by the needle, either
into the muscles or into a vein; but, as a rule, this should not be done
save by the medical attendant. It should, however, be remembered that
the drug may be given by the bowel, in which case twice the quantity of
quinine which would be administered by the mouth should be given. It is
only exceptionally that this procedure will have to be followed, but it
is sometimes useful in the case of children.
Public-domain text, read in full here on John Shaqi.
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