Treatment

At the commencement it is good practice to clear out the stomach and bowels with a good purgative; any one prescribed in this work will answer; and then: The remedy upon which most reliance has been placed, for many years, and in most countries, is Quinine, and next to Quinine is Arsenic. The best way of using Quinine is to give a dose about an hour before the cold fit is expected, which will frequently have the effect of preventing the fit altogether, in which case the Quinine may be continued every four hours. In order to get the full benefit of the remedy, and prevent the return of the fever, it is necessary to continue the use of the Quinine for some days after the patient seems to be cured. It may be given in one or two grain doses. If the drug is good, I have generally found this sufficient. The Quinine must not be given during the hot stage; but the following Mixture may be substituted, and continued during the hot and sweating stages; when these are passed the Quinine may be resumed:

Bi-carbonate of Potash.................Three Drams.

Citric Acid...............................Two Drams and a half.

Compound Tincture of Cardamoms.Half an Ounce.

Syrup.....................................Half an Ounce.

Water, sufficient to make...........Half a Pint.

A tablespoonful every two or three hours.

Many other remedies have been used as cures for Ague, and they have most of them been successful in some cases. Arsenic has been much used. Sir Thomas Watson says: "It carries with it the marked advantages: it is efficacious; it is cheap; and it is tasteless. It is well adapted by these qualities for the poor, and for children, and for patients of every age and rank in whom there is much irritability of stomach present; but then it has also the serious disadvantage of being an active poison. One over-dose might be fatal: and even its long-continued use in minute doses leads sometimes to evident and lasting disorder of the health. Arsenic, therefore, is an unsafe remedy to be trusted in the hands of the ignorant. It should never be administered except under the immediate supervision of a medical eye; and even then it requires to be given with much caution."

Opium has frequently been given with success. Dr. Trotter says: "Agues being very frequent among the crew of the Vengeance, I resolved to try the full effect of Opium in preventing the fit. At its first approach (the shivering fit) a dose of Laudanum (never less than thirty drops) was given; if this did not bring on some warmth within ten or fifteen minutes, from twelve to twenty drops more were administered. In most cases, in a few minutes an exhilaration of spirits was perceived: the puke, from being weak, quick and sometimes irregular, became full, less frequent, and equal; an agreeable warmth was diffused over the whole frame, and every unpleasant feeling vanished, sometimes in a quarter of an hour. The patients were themselves surprised at the sudden change in their sensations.

"Dr. Moxon recommends Bromide of Potash for the cure of Ague, It was first introduced into practice as a remedy for enlarged spleen [which is often the result of Ague] and has been found to have great power over Ague. In one case, illustrative of its action, the patient had had Tertian Ague for two months before admission to the hospital, and had taken Quinine without benefit: after admission he took 84 grains more without benefit. Twenty grain doses of Bromide, three times a day, were then given, and he was discharged cured in ten days. It is found always to check the Ague, and often to cure it permanently, not always, but that is the case with any remedy."

The best form for the administration of Quinine, is one of the following:

Quinine.......................................Eight Grains.

Diluted Sulphuric Acid..................Twenty-four Minims.

Compound Tincture of Cardamoms...One Ounce.

Syrup........................................One Ounce.

Water, sufficient to make................Half a Pint.

or

Quinine......................................Eight Grains.

Diluted Nitric Acid......................Twenty-four Minims..

Tincture of Orange Peel................One Ounce.

Syrup.......................................One Ounce.

Water, sufficient to make...............Half a Pint.

Two tablespoonfuls every three or four hours.

If the quantity of Quinine is increased, the quantity of acid must be increased in proportion.

Willow Bark, which contains a bitter salt (Salicine) somewhat resembling Quinine, is said to have been effectual in curing some cases of Ague; and at one time Chamomile Flowers were in great repute for that purpose.

It is a well ascertained 'fact, that in some cases, when .Quinine fails to effect a cure, the Peruvian Bark itself will do it. Is there not, in these cases, strong reason to doubt the goodness of the Quinine.

Persons who have once had the fever, should, in whatever place they may happen to be, avoid over-fatigue, and exhaustion of all kinds; sudden exposure to heat and cold; and should never neglect changing wet clothes, or wet shoes and stockings. In a malarious district, persons should bear in mind that the miasmata are much more virulent in the night-time than in the day; and close to the surface of the earth, than in a higher part of the atmosphere. They should refrain therefore, from going out late in the evening, or early in the morning, and should not sleep on the ground floor. They should always have fires lit in the house in damp weather, during the spring and autumn months. They should also get a good hot breakfast in the morning before going out, and not go out fasting.