American Materia Medica, Therapeutics and Pharmacognosy

Quinine destroys the plasmodium malariae readily, even in the minute
quantity of one part to twenty thousand of water. Its influence upon
malarial conditions can thus be readily understood.
Therapy—In the administration of quinine as an antiperiodic, the
beneficial influences are not altogether in proportion to the size of the
dose. Enormous doses may abort a chill if given during its course, or
during the course of the fever. They are very likely, however, to increase
the nervous erethism and the temperature; whereas, if proper doses be
given during the intermission, from one to three hours preceding the
anticipated attack, or at the time when the temperature has reached its
lowest point, small doses will accomplish positive results.
In continued fever, with a sufficiently marked remission occurring at a
given time each day, or on each alternate day, the agent should be given
during the remission, provided the temperature declines to a point
sufficiently low to admit of a temporary restoration of the suspended
secretions. This point is usually not above 100 1/2 degrees. If the
remission be short, a single dose may be given. As a result the
temperature does not run quite as high as on the previous day, and the
next remission is more marked and of longer duration. At this time,
perhaps, two full doses, two hours apart, may be given. The fever is still
lower and the remission so marked by the third day that the agent, in
reasonable doses, may be continued through the exacerbation, the
temperature at no time, probably, rising above 101 degrees and not
increasing above normal after the third day.
The writer has adopted this course for so many years, with perfectly
satisfactory results, that the method is confirmed in his mind as the
proper one in all cases where malaria is the cause,
Where continued fever exists, quinine is of no benefit if there is no
marked remission or other evidence of malaria. It is thus of no use during
the progress of typhus, typhoid and other protracted fevers. In such cases
it causes nerve irritation and increased temperature, especially if there is
deficient secretion.
When the fever is broken and there is a tendency toward a restoration of
secretion, and the temperature is normal or subnormal, then this agent is
a vitally important one. Here the bisulphate, being readily absorbed,
Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 128