Fever in the Zambesi (1861)

In the typical cases given in Dr. McWilliam's Medical History of the Niger Expedition , the gallbladder was found distended with black bile; and, if my memory do not deceive me, most of the cases treated with quinine at an early period of the disease either recovered, or were subjected to the milder or intermittent form of fever.

In 1850, I adopted the plan of giving quinine mixed with a purgative as the first step of the treatment, and was successful in the cases of two of my own children and an English party whom we found at Lake Nigami, and of whom one had died before our arrival. I have lost the notes of my reasons for adopting the practice; but I have been successful in every case I have met with since. The prescription employed is resin of jalap and calomel, of each eight grains; quinine and rhubarb, of each four grains. Mix well together; and, when required, make it into pills with the spirit of cardamom. Dose, from ten to twenty grains. The violent headache, pains in the back, etc., are all relieved in from four to six hours; and with the operation of the medicine there is an enormous discharge of black bile; the patient frequently calls it blood. If the operation be delayed, a dessert-spoonful of salts promotes the action. Quinine is then given till the ears ring, etc. We have tried to substitute other purgatives instead of the resin of jalap and calomel; but experiments have only produced the conviction that aught else is mere trifling. No strength is lost in our march up the river of six hundred miles on foot. An European would be stricken down in one day, and the next after the operation of the remedy would resume his march on foot. In some very severe attacks, it was necessary for the patient to travel upon a donkey; but, after two or three days, he would prefer to tramp it.
Livingstone D. Fever in the Zambesi. BMJ 1861;1:681-2,


BMJ 2009;339:b2245