of even small doses of quinine; some cannot take it on this account, and prefer to endure the disease rather than suffer the intolerable irritation induced by the remedy. I believe that nothing is gained by excessive doses; in ordinary circumstances, 30 gr. spread over two or three days is usually ample to check an intermittent.
In the endemic area of hæmoglobinuric fever, and even in the case of individuals who have long left that endemic area, large doses of quinine do sometimes undoubtedly determine an explosion of that highly dangerous disease, especially so, but not exclusively so, in the cachectic. This important fact must not be lost sight of, and when there is any good reason to apprehend such a calamity, quinine should be given at first in ½-gr. or 1-gr. doses, gradually increased to 5 gr. or more three or four times a day.
For children under one year, ½ to 1 gr. for a dose suffices; for older children the dose must be increased proportionately to age and strength. Children tolerate the drug well, so that in serious cases—— pernicious comatose or other cerebral forms—— the drug should be vigorously pushed.
If a supposed ague resist the doses of quinine mentioned, the diagnosis should be revised.
Quinine in pregnancy.—— Care should be exercised in giving quinine to pregnant females, for undoubtedly it sometimes causes miscarriage. The fact of pregnancy, however, must not debar the use of the drug altogether; only, in such circumstances, it should be given in the minimum dose likely to be effectual, say 3 gr. repeated every eight hours for two days. A pregnant woman will run more risk of miscarriage and of detriment to her health from repeated ague fits than from a reasonable dose of quinine.
Quinine in the puerperal state.—— It is a wise precaution in malarious countries to give a few 5-gr. doses of quinine during labour or soon after. The puerperal state seems to have the effect, as any other shock or physiological strain might, of waking up the slumbering malaria parasite. A dose or two of quinine in these circumstances does no harm,
