How to use quinin and urea hydrochlorid : especially for systemic effect by injection in malaria and pneumonia / Solomon Solis Cohen.

  • Solis-Cohen, Solomon, 1857-1948.
Date:
1912
Catalogue details

Licence: In copyright

Credit: How to use quinin and urea hydrochlorid : especially for systemic effect by injection in malaria and pneumonia / Solomon Solis Cohen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    possibly it is merely a question of solubility. I do not know the explanation, but the fact is evident. The peculiar advantage of the urea compound over the other quinin salts, however, is its availability for hypodermic and intramuscular injections; possibly for intravenous injection also, although I have never found the latter method necessary and thus have no experience to report. A possible danger is injury to the vessel wall. The superiority of the carbamide for injections is owing to its high solubility. It will dissolve in its own weight of water, especially hot water, and an ordinary syringeful may thus con- tain from 15 to 18 grains (1 to 1.2 gm.) if necessary. The preferable solution is 50 per cent., and the ordinary dose is 1 gm. (15 grains) in 2 c.c. of water. In malaria of the types ordinarily seen in northern latitudes, a single injection of this strength will cause suspension of the paroxysms for from a week to a fortnight (6j/2 to days). One injection daily for a week suffices to bring about complete recovery in the ordinary case. After this, to make sure against chronic infection or sequels, the drug should be continued in doses of 10 grains, in capsule by the mouth, daily, for another week; and then administered once a week, in the same way, for two or three months. In pernicious malaria, larger and more frequent doses are probably needed. In pneumonia, the dose varies with the age and vigor of the patient, the general severity of the case and the time elapsing from initial chill to the beginning of treatment. If the case is seen on the first day, and the patient is a vigorous adult under 50 years of age, the effort should be made to give as much quinin as possible within the first 24 hours. The initial injection may be 25 grains (1.6 gm.), and this, or a smaller dose, may be repeated in three or four hours, according to the effect produced. Aged persons, weak persons, children receive proportionately smaller doses. Should the case be first seen on the third day, the initial dose should be governed somewhat by the height of the temperature and the severity of the gen- eral symptoms. If the temperature exceeds 104° F., and the patient markedly labors for breath, the first injection may be 25 grains; otherwise 15 grains should be given and this dose repeated every third hour or fourth hour, according to cir- cumstances, until the temperature falls and remains below 102.2° F.; to be repeated when the temperature again rises. While the object of the treatment is not antipyretic, the tem- perature line of 102° F. is taken as an approximate index of the severity of the infection, or rather of the toxemia, on the one hand, and on the other hand, of the adequacy of the pa- tient’s reaction. It is not desirable to reduce temperature abruptly below 102° by any form of treatment, except, perhaps, the use of specific bacterin.