SUPPLEMENT 635 



As regards the diagnosis of malaria, according to Manson the 

 three pathognomonic signs are periodicity, the effect of quinine, and 

 the presence of the malarial parasite. 



Treatment. The great specific for malaria is quinine. It attacks 

 the merozoites or asexual generation. The drug can be adminis- 

 tered by the mouth, by the rectum, by intramuscular injections or 

 by intravenous injections, the two latter methods being adopted in 

 serious infections or where gastric complications are present. When 

 quinine is taken by the mouth, the more soluble acid salts, e.g., 

 quinine bihydrochloride and bisulphate, are better than the sulphate, 

 the form in which quinine is usually sold. Tablets, pills and cap- 

 sules are convenient means of taking quinine but must not be old 

 or hard, or they may pass unchanged through the body. In the 

 case of mild tertian or quartan malaria, Castellani and Chalmers 

 recommend the administration of a dose of quinine four hours 

 before the sporulation of the parasite is due. Another modification 

 is to give 10 gr. of quinine by the mouth in the morning and a second 

 dose of 10 gr. as above. In many cases they give 5 to 10 gr. 

 of the drug three times a day. Administration of quinine per 

 rectum may be useful but they recommend intramuscular inocula- 

 tion. The solutions used must be sterile, and the " sterilettes,' 1 

 small, hermetically sealed vials, containing i grm. (15 gr.) or J grm. 

 (7i g r -) f quinine in solution, are recommended. A deep injection 

 into the deltoid or glutens muscle is usual. 



For pernicious infections, intravenous inoculation with not less 

 than i grm. at a time is recommended. 



After the fever has subsided, the administration of quinine in 

 smaller doses must be continued for some time, in order to avoid 

 relapses. 



Stitt (1914) writes that " there now seems to be a tendency to use 

 the alkaloid itself instead of its salts, it having been found that the 

 alkaloid and its very insoluble tannate are absorbed from the digestive 

 tract equally as well as the soluble salts." Euquinine or ethylcar- 

 bonate of quinine contains 81 per cent, of quinine, but is expensive. 



During malarial attacks, constipation must not be allowed. 

 Headache can be relieved by cold applications, and perspiration must 

 be encouraged in the early stage by hot tea, warm lime drinks, etc. 

 After bad attacks, a change to a cooler climate is desirable, but the 

 quinine treatment must not be discontinued. 



Preventive measures take two main forms, directed respectively 

 against the malarial parasites in man, and against the mosquitoes 

 that convey the parasite from man to man. 



With regard to man, houses should be built away from low- 

 lying marshy ground, and kept free from vegetation such as grass or 

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