The diagnostics and treatment of tropical diseasesStitt, E. R. (Edward Rhodes)
Science
The diagnostics and treatment of tropical diseases
Stitt, E. R. (Edward Rhodes)
Tropical medicine
In giving the small doses one should see that they are given during
the night as well as the day.
_Quinine and Pregnancy._—There is frequently hesitancy in giving
quinine to a pregnant woman but unless the malaria is controlled
the patient will be apt to abort. Potassium bromide is thought to
control the ecbolic influences of quinine.
Clark states that the experience at Ancon Hospital would indicate
that quinine can be given with impunity to pregnant women. In
malarial subjects quinine after parturition is of value not only in
controlling a fever due to malaria but it also favors involution
and aids in the healing of perineal tears. The quinine also is
beneficial in improving the quality of the mother’s milk and does
no harm to the child.
_Manson’s Method._—In a benign malarial infection Manson prefers to
wait until the hot stage has been passed and the patient is beginning
to perspire, this idea being that the headache and other symptoms
are aggravated and that very little advantage is gained by treatment
during the early part of the paroxysm. He gives 10 grains at the
onset of the sweating stage and afterward 5 grains, 3 or 4 times
daily, for the following week. He then gives a daily tonic containing
arsenic and iron, with a quinine treatment every seventh day for
about two months.
For regularity he advises the quinine treatment on Sunday giving a
dose of salts in the morning followed by three 5-grain doses during
the day.
Manson notes the danger of large doses of quinine as producing
not only serious disturbances of sight and hearing but pronounced
cardiac depression as well.
There are many who speak highly of Warburg’s tincture in treatment.
It is both laxative and sudorific. The dose is ½ ounce (15 cc.)
which contains about 5 grains of quinine sulphate and 4 grains of
extract of aloes. As a rule it is better to give the quinine and
the laxative separately.
More recently the tendency has been to give large doses of
quinine, not only for its greater curative value but, as well, for
the prevention of relapses. Craig, however, states that in his
experience with aestivo-autumnal infections he has yet to see a
single case, in which treatment was promptly instituted, that did
not recover with a daily treatment of 30 grains.
_Koch’s Method._—Koch recommended 15 grains each day for a week,
then three days without quinine. Then three days with 15-grain doses
each day. Then one week without quinine, followed by three days of
treatment. This plan of a weekly interval followed by three days of
treatment is continued until not fewer than 30 15-grain doses are
given over nine or ten weeks.
_Drugs Other than Quinine._—Salvarsan and neosalvarsan have been
extensively used and with some success in benign infections but
without material effect in malignant tertian ones.
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