When any affection assumes a periodical type or character, particularly if there be reason to suspect a malarious origin or influence, Quinine is indicated, and will be found efficacious, even where other circumstances might appear to warrant some other mode of treatment.
In Intermittent Angina Pectoris, Dr. Forbes * advises the use of Quinine. In Spasmodic Asthma assuming a periodical character, it often proves effectual. Great caution, however, is requisite in its use: unless the periodic type is well marked, if given injudiciously, it will prove injurious. Floyer, Bree, Ryan, and others, advocate its use in the periodic form; and Dr. Hogan relates many cases in which, in doses of gr. iij. - viij., it proved most successful. In Intermittent Hemicrania, Headache, Brow Ague, Tic Douloureux, and other Neuralgic Affections, it has proved effectual in the hands of Drs. Elliotson, Hunt, § Sir B. Brodie.|| &c. In Intermittent Hiccough, it has also been used with success¶ Dr. Lohman** mentions a case of Intermittent Ophthalmia which yielded to its use; and Sir B. Brodie found it effect a cure in a case of periodical Stricture of the Urethra. Hag Fever or Hay Asthma, when it assumes a periodic form, usually yields rapidly to the exhibition of Quinine.
vj. daily is generally sufficient, but larger doses are sometimes necessary. Mr. Hogg advises gr. x. with Acid Sulph. Dil. ex. in a single dose. He found that this generally arrested the progress of the disease, and that he had seldom occasion to repeat the dose.
Haygarth,§§ in 1772; and subsequently by Dr. Lettsom, Dr. Heberden, Sir Walter Farquhar, and others. Dr. Haygarth first administered Tartar Emetic until the stomach and bowels were sufficiently cleansed, and then commenced with Cinchona, at first in small doses, and, if they did not disagree, in larger ones; in some instances he employed blood-letting by the lancet, or by leeches, or by both. He adds that, with but few exceptions, the bark produced the most salutary effects. It was always discontinued if it disagreed, or increased the fever; and Antimony was again had recourse to. This line of practice, however, fell into disuse till a recent period, when the French physicians re-introduced a similar mode of treatment, substituting Quinine for the crude bark. M. Briquet * states that, given in the following large doses, it proves of the highest value. On the first day, 3j. - 3iss. (according to the age of the patient) is given in divided doses, in the course of twelve hours. The same doses are repeated on the second and third days, by which time the severity of the symptoms were usually abated, and the doses are gradually diminished, at the rate of gr. xv., daily. The average duration of the pain and swelling of the joints was from three to five days. In more than one-third, there was cardiac complication, recent or chronic. In all but four cases, out of the twenty-three of which he gives a detailed account, there was marked abatement of the symptoms in twenty-four hours. Relapses occurred in two only. M. Devergie. in testing Briquet's statements, commenced with smaller doses, and gradually increased them. He confirms Briquet's views of the value of Quinine in this disease, excepting that he found smaller doses answer all the purposes of the larger ones. Many other French physicians advocated the practice; but some fatal cases in the hospitals of Paris having occurred under this system, it has been in a great measure abandoned.
* Cyc. Pract. Med., vol. i. p. 95. Amer. Med. Intel., Feb. 1842. Med. Gaz., vol. vii. p. 468. § On Tic Douloureux, &c, 8vo, 1844. || On Local Affections,, p. 28.
¶ Med.-Chir. Rev., Jan. 1842. ** Med. Times, vol. xviii. p. 89. Dis. of Urinary Organs, p. 40. Lancet, Nov. 1850. §§ Clinical Hist. of Acute Rheumatism, Lond. 1805.
2331. In Enlargement of the Spleen, co-existing with intermittent fever, the most efficacious remedy which we possess is the Sulphate of Quinine, in doses of gr. xv. - xx. daily. M. Nonant, and other French writers, advise it in much larger doses (gr. xl. - 1.), which are to be persevered in until the spleen returns to its normal size. It may not be out of place here, to mention that Piorry's proposition, that enlargement of the spleen is the actual cause of intermittents, has been ably disproved by Dr. George Smith,§ of the Madras Medical Service, who, out of 4,000 cases of well-marked ague, was unable to detect any affection of the spleen, excepting in a few rare cases. Piorry also relates numerous cases and experiments, to show the influence of Quinine on enlarged spleen; one example will suffice. In several dogs the spleen was uncovered, and several liquids were injected into that viscus without producing any change in its size. An alcoholic solution of Quinine was then injected, and within one second the spleen contracted, and lost 1/3 of its volume in one animal, and 1/6 in the others. The same marked and uniform effect is not produced when the medicine is given internally, as will be seen on reference to the subjoined table, given by Dr. Smith: -
* Gaz. des Hopitaux, Nov. 17,1850. Gaz. Med dicale, Dec. 30, 1842. Med.-Chir. Rev., July 1840.
§ Medical Reports, Madras, 1850, p. 103; and Ranking's Half-Yearly Abstract, vol xiv. p. 227.
Size of the Spleen.
Dose of Quinine given.
Time which elapsed before effect seen.
Amount of reduction.
No effect observed..
1/4 of an inch.
3/4 of an inch.
1/2 an inch.
Most marked reduction.
1/2 an inch.
1 1/2 inches.
3 1/4 inches.
From this table, it appears that the remedy failed entirely in six cases. Of the eleven benefited, seven proved permanent, and four temporary, the spleen in these last having regained its previous volume.