As for the dose in which sulphate of quinine ought to be prescribed, it depends on the age, sex, and temperament of the patients. For adults and men, the average is twenty grains in a single dose, in about three ounces of black coffee, without sugar. If it is feared, that the irritated stomach cannot bear so strong a dose, it should be dissolved in a few ounces of distilled water with a sufficient quantity of sulphuric acid, and given every hour by the large spoonful. If the stomach cannot bear this, give an injection of a double dose, with the precaution, not to inject more than one ounce of liquid at once, every hour. The action of the medicine will be assisted by friction of quinine ointment along the vertebral column, on the articulations of the wrist, knees, and under the arm-pits, etc.
Some enthusiasts consider sulphate of quinine, as a preventive, and direct it to be taken in a perfect state of health, or administer it in the outset of the fever. I have tried this without having felicitated myself. I will say as much of the association of calomel with sulphate of quinine. This combination should be rejected.
I have nothing to add to what I have already said as to blisters.
Bicarbonate of Soda—Nux Vomica.—When the patient complains of nausea, disposition to vomit, of eructations warm and acid, that he feels in the throat and liver a burning sensation, bicarbonate of soda is the remedy indicated. I give it in doses of one gramme in six ounces of distilled water, taken by the spoonful every hour.
I have stated before, how and under what circumstances nux vomica ought to be given. The effect of these two last remedies is often much more sure, if their action is assisted by cold fomentations upon the abdomen, perhaps with cold water alone, or with camphorated alcohol and belladonna.
Belladonna—Camphor.—Compresses of camphorated alcohol and belladonna, placed upon the epigastric region, diminish the beating of the cœliac trunk, the epigastric pain, and the vomiting. Laid at the bottom of the abdomen, they quiet the colic pains and facilitate the passage of urine. Camphor alternated with belladonna, finds its use internally, in combatting hiccough, and camphor alone is especially useful in the typhoid period of the disease.
Tannin.—Tannin diminishes the excitement of the stomach. I recommend its employment, where nitric acid reveals the commencement of albuminous deposit in the urine. Its use must be suspended, if the albumen persists or increases. Tannin is administered every hour, in grain doses in a spoonful of water. When the twelfth grain has been given, and it works no favorable change, it is replaced by arsenic.
Arsenic.—Towards the end of the second period, when the vomiting cannot be arrested, when the patient has continual nausea, when the vomit contains bile or mucosities filled with blackish or sanguinolent streaks, in a word when the characteristic signs of pronounced yellow fever are developed, there is no better remedy than arsenic. It is given as arsenious acid dissolved in water, and prepared in the following manner: Boil for an hour a grain of arsenious acid in a porcelain cup, containing a half pint of distilled water; then replace the evaporated liquid with an equal volume of boiling water, let it cool, and give this solution by the teaspoonful every half hour, until the nausea and vomiting cease. The administration of this remedy is continued for two days, at longer intervals, that is every hour, then every two hours, finally every four hours. Prescribed under fitting circumstances, arsenic often brings unhoped for amelioration.
There are some medicines, whose action, though certain, is inexplicable. Such is arsenic, the influence of which must be accepted as a fact, without considering theories more or less satisfactory. I should add, that arsenic often determines a deceptive hunger, to which there should be no concession, because at this period of the disease, the lightest broth might cause fatal indigestion.
I have tried every possible remedy for black vomit, and there is not one, which has constantly given the same result. I have had extraordinary success with agents, which at other times produced no effect; and I affirm, that there is no therapeutic agent, which can always be employed with entire confidence. Black vomit is the symptom of alteration, more or less profound, of the bile and of the blood. If it is alteration of the bile, presenting solely the black color of jet, hope remains; but when the vomited matter is of the color and consistency of coffee grounds, the patient is irretrievably lost. This truth rests on an experience of forty years.