SUPPLEMENT 633 



Chalmers and O'Farrell 1 (1913), writing from Khartoum, re- 

 commended rest in bed, good food and ventilation, coupled with 

 treatment by arsenic in some form, preferably associated with glycero- 

 phosphates. These may be given by the mouth, or intramuscularly 

 as an injection of : 



Sodium cinnamate ... ... ... ... 0^05 grm. 



Sodium cacodylate ... ... ... o'io ,, 



Sodium glycerophosphate ... ... ... o'lo ,, 



Taylor 2 (1913-14), writing from Entebbe, Uganda, prescribes 

 arsenious acid by the mouth in increasing doses. Creosote has been 

 used in West Africa. 



YL MALARIA. 



Malaria, known also under the names of ague, paludism, marsh 

 fever, remittent fever, intermittent fever and climatic fever, among 

 others, is a very widely spread disease. It is most prevalent in the 

 equatorial regions and gradually diminishes north and south of the 

 equator. The various malarial parasites (see pp. 155 to 172) are spread 

 by species of Anophelines, and hence malaria is present in districts 

 favourable to these intermediate hosts, that is, in places where there 

 is a considerable amount of atmospheric moisture and rain, as well 

 as heat. 



The principal malarial parasites are : Plasmodium vivax, the agent 

 of simple tertian fever ; Plasmodium malaria, the parasite of quartan 

 malaria, and Laverania malaria or Plasmodium falciparum, producing 

 malignant tertian or sub-tertian malaria (and quotidian, see p. 167). 

 These various malarial fevers present certain clinical features in 

 common, which will be stated here (see also pp. 155 to 157). 

 For further particulars regarding malaria in all its aspects the reader 

 is referred to the book by Sir Ronald Ross on " The Prevention of 

 Malaria," to the " Manual of Tropical Medicine," by Drs. Castellan i 

 and Chalmers, and to the "Tropical Diseases " of Sir Patrick Manson. 



Typical malarial fevers consist of a series of pyrexial attacks which 

 recur at definite intervals of twenty-four (quotidian), forty-eight or 

 seventy- two hours, according to the parasite present in the patient's 

 blood. Each attack shows three stages, a stage of rigor, a heat stage 

 and a stage of profuse perspiration. Following on these three stages, 

 there is an interval relatively or actually without pyrexia. Then the 

 fever returns again. A rise of temperature, often accompanied by a 

 general feeling of malaise, may precede the initial stage of rigor. When 

 the latter sets in, the patient feels intensely cold, shivers violently, the 

 skin becomes cold and the features pinched. There may be violent 



1 fourn. Trap. Med. and Hyg., xvi, p. 329. 



2 Annual Med. and Sanit. Kept., Uganda, for 1913, p. 80. 



