REVIEW — TROPICAL iMEDICINE, ETC. 117 



I have never seen symptoms of cinclionism from this method. I would add that all the cases are diagnosed by Malaria — 

 the finding of the plasmodium malarise before the quinine is given, even if it means the patient remaining a few continued 



days in the wards before he receives any specific treatment. 



Eogers gives data to show that 10 grain closes three times a day are sufficient to cut 

 short an ordinary attack of malaria in one to four days, while four to six such doses in 

 the course of the twenty-four hours do not have any more rapid effect, although they are 

 advisable if the infection is found by the microscope to be a severe one. In children (he 

 says, confirming Holt) there is a tendency to give too small doses of this drug. One grain 

 for each year of age may safely be given two or three times a day up to the age of 10, so 

 that over 10 years a full adult dose should be given twice a day. Infants may receive 

 2 or 3 grain doses twice a day. 



Strychnine is valuable to counteract depression. 



As a general rule the drug should be given without regard to the temperature and 

 without waiting for an intermission of the fever, but it may sometimes be advisable to throw 

 in a larger dose, such as 15 or 20 grains, during a remission or intermission of the pyrexia. 



Eogers does not find that, when given hypodermically, the drug acts more effectively and 

 rapidly. He utters a warning against the risk of tetanus, suggesting that quinine may act 

 in symbiosis with the tetanus bacillus, or possibly by paralysing the phagocytes and thus 

 favouring the bacillary action. He much prefers intravenous injections which should always 

 be used when unusually severe infection is found by the microscope and before any cerebral 

 symptoms have appeared. To wait for coma, it may be said, is usually to wait for death ! 

 The soluble bi-hydrochlorate should be given, preferably along with strychnine. 



He mentions rectal injections administered high up the bowel, and I may mention that 

 Dr. Daniels told me it was the rule in the Malay States to employ this method in all very 

 severe cases with brain symptoms. 



The drug should be continued in 20 to 30 grain daily doses for a week or two after the 

 pyrexia ceases. Thereafter 10 grains a day for one month from the date of attack. Then 

 prophylactic doses twice a week as already indicated, for two months, or until the end of 

 the malarial season if still exposed to infection. 



Euquinine is indicated when gastric or intestinal catarrh is present, for the treatment 

 of children or where quinine causes ill effects ; 15 grains is the dose for adults. 



One finds little said about quinine given in effervescing form, but personally I have 

 found that quinine and citric acid, given along with carbonate of ammonia and potassium 

 bicarbonate in an effervescing mixture, is not only very efficacious in malaria but after the 

 attack acts as an excellent tonic, improving appetite and imparting energy. I am inclined 

 to agree with Burney Yeo that one gets the full effect of the drug with smaller doses when 

 it is administered in this fashion, and that it is more easily retained and assimilated. 



The acetyl-salicylate of quinine has recently appeared and is said to be useful, the 

 effect of the drug being obtained only when the salt reaches the alkaline contents of 

 the intestine. 



Carpenter^* strongly advocates fresh splenic extract given as powder in capsules in 

 5 grain doses every four hours. In quartan and estivo-autumnal types a biematinic 

 is usually required in addition, but in the acute tertian and quotidian forms the splenic 

 extract alone is sufficient. 



Slatincano and Galesesco-* report favourably on atoxyl injection (doses 50 cgr.) in cases 

 of tertian infection. Apparently the single injection was followed by complete cure. 



For enlarged malarial spleens Johnston^ finds that injections of bisulphate of quinine 

 with iron tonics internally, and the application of flying blisters, is much to be preferred to 

 the old routine treatment of iron and quinine internally and the local application of red 

 iodide ointment. 



Since the above was written, a very important paper by Celli,* on the campaign against 

 malaria in Italy, has appeared. As regards prophylaxis, he differs in certain respects from 



> Carpenter, C. R. (August 4th, 1906). Medical Record. 



- Slatincano, A., and Galesesco, P. (December 14th, 1907). Compl. IL Soc. Biol. 



= Johnston, C. A. (May, 1906), " Enlarged Spleen and Its Treatment." Indian Medical Gazette, p. 179. 



■• Celli, A. (April 1st, 1908), " The Campaign against Malaria in Italy." Translated by .J. J. Eyre, 

 Journal of Tropical Medicine and Hygiene, p. 101. 



• Article not consulted in the original. 



