In 1763, Dr. Fothergill and Dr. Fordyce recommended Cinchona in this affection, but to Dr. Middiemore is due the credit of bringing the practice prominently forward and establishing its use. Dr. Mackenzie § considers that the treatment of Scrofulous Ophthalmia with the Sulphate of Quinine is an improvement in ophthalmic medicine scarcely less important than " the treatment of Iritis with Mercury." The dose for a child may be gr. j. thrice daily; that for an adult, gr. ij. - iij., at the same periods. Brisk purgatives should precede its exhibition; a light nutritious diet should be allowed. In Nyctalopia and Hemeralopia, Mr. Howard, || of Montreal, states that the treatment which he has found most effectual is, after the exhibition of a cathartic and emetic, to administer Quinine in as large doses as the stomach can bear. In Acute and Chronic Iritis, he speaks highly of the value of the combination of Calomel and Quinine, the former being omitted when the gums become sore, but the latter to be continued.
2339. In Puerperal Insanity, if the skin be relaxed, and there exist a disposition to free and copious exudation, the Sulphate of Quinine, with the mineral acids, in considerable doses, will be of service. (Dr. Prichard.¶)
Copland ** observes that Cinchona, or the Sulphate of Quinine - the latter especially - is often preferable to other tonics, more particularly in the intermittent forms of the disease. The infusion of bark with the solution of the Acetate of Ammonia is most suitable when vascular or nervous excitement is passing into exhaustion, or in cases where the propriety of having recourse to tonics may seem doubtful. In circumstances of obvious exhaustion or inanition, in the more purely nervous states of the disorder, in advanced stages after evacuations have been carried sufficiently far, or where the head is cool and the pulsations of the carotid are not increased in strength or fulness, the Sulphate of Quinine, either alone or with Camphor, and with the Extract of Aloes, if the bowels require to be kept freely open, will often be of service. He advises two formula?: the first, when the bowels are costive; the second, when they are relaxed: - 1. ℞ QuinAe Disulph. 3ss., Camphor ij., Ext. Aloes Pur. 3ss. - ij., Ext. Hyoscyam. 3iss., Balsam. Peruv. q. s. ft. pil. L, cap. iij. bis terve in die. 2.℞ QuimAe Disulph. j., Camphor, 3ss., Pil Sapon.c.Opio 3j., Syrup, q. s. ft. pil xxxvj., cap. ij. vel iij. bis in die.
|| Pathology of the Eye, p. 503. ¶ Lib. of Med., vol. ii. p. 142. ** Dict. Pract. Med., vol. ii. p. 533.
2341. In Epilepsy, Cinchona was prescribed by Home,* and others; and, in Chorea, it has also been employed in some instances with advantage. It has been conveniently replaced by Quinine, which may prove serviceable when judiciously administered. It is chiefly indicated when the disease is of a purely nervous character, or when it assumes a periodic character, when the powers of life are much depressed, and there is much exhaustion of the nervous energy. In these cases Dr. Brown-Sequard prescribes Quinine in large doses (gra. v. - x. - xv.) at intervals, just before the fit is expected. By this means he states the fit is frequently prevented, and the patient goes on to the next or even to a longer period. It is inadmissible until the bowels have been freely evacuated, when there is much gastric irritation, or a plethoric condition of the brain, or of the system generally. Under the circumstances above indicated, it may be advantageously combined with the Sulphate of Iron.
2342. In Tetanus, Quinine has been employed in numerous cases, and apparently with the best effect; in some, however, so many other measures were combined with the internal administration of Quinine, that it is difficult to say how far this medicine aided in effecting a cure. In a case under the care of Mr. E. Cock, at Guy's Hospital, the patient, a youth Aet, 18, took three grains of Quinine every four hours, with 12 oz. of Wine daily, and in the eleventh week after admission, the tetanic symptoms having gradually subsided, the patient was discharged. Another case of traumatic Tetanus, treated with Quinine, is related by M. Coste,§ the disease arose in consequence of a contused wound of the toes, and was arrested by large doses of the Sulphate (maximum, gr. xlv. in one day), after bleeding, baths, &c, had in vain been resorted to. The cure was effected in about a fortnight If the patient is unable to swallow, the medicine may be given in the form of enema.
* Clinical Experiments, &c.,p. 194. Med.Timesand Gaz.,Oct. 27,1860.
Lancet, June 28, 1851. § Ibid, July 5, 1851 (B).
2343. In Gangrene and Mortification, Cinchona has long been held in high esteem, and when these states are attended with great prostration of the vital powers, a debilitated state of the constitution, and general cachexia, or typhoid symptoms, its internal exhibition is followed by the best effects. It is not applicable to all cases, particularly when the digestive organs are much deranged. As a general rule, the decoction of Cinchona, with a small portion of the mineral acids, has a better effect than Quinine; but there are exceptions to this rule, as, for instance, when the digestive organs are impaired and unable easily to bear the quantity of bark which it is necessary to exhibit in order to produce a constitutional effect. Quinine may then be advantageously substituted.
2344. In Cancrum Oris, the constitution requires tonics, stimulants, &c, in order to support the strength. Dr. Graves * strongly recommends Quinine, either in the form of enema, or made into a syrup, and flavoured with dilute Sulphuric Acid. In Aphthous Ulcerations, when the constitution is much debilitated, it also proves highly serviceable.
2345. In Scurvy, attended with much prostration, Quinine may be given with great advantage. Much evident improvement follows its use, particularly when given with the mineral acids. It need not interfere with the use of Potash, Lemon-juice, or other anti-scorbutics. A decoction or the diluted tincture of Cinchona forms a very useful gargle. Myrrh or the Chlorates may be conjoined with it.