MALARIA 



103 



hepatitis. The latter will mask it by producing an increase of other 

 leucocytes. Children commonly have mononuclear increase without 

 any disease (Daniels). 



PROGNOSIS. 



The mortality amongst natives is usually low. 



In Europeans resident in the tropics it is high, Africa in particular. 



Simple tertian and quartan parasites give the best prognosis. 



Subtertian is always grave; pernicious symptoms deadly. 



People unable to take quinine should not be allowed to reside in 

 the tropics, e.g., malarial countries. 



Complications always make the outlook more serious, especially 

 typhoid fever and pneumonia. 



Syphilis in a malarial patient will not vield to anti-syphilitic treat- 

 ment until the malaria has been cleared up. 



Ross gives us the following interesting figures for India : — 



The mortality is 5 per 1,000 living, or 1,150,000 per annum. 



It is greater than the mortality of cholera and dysentery combined. 



A quarter to one-half of all tropical sickness is due to malaria. 



Malaria tends to abound in the most fertile countries, hence very 

 malarial countries cannot be prosperous. 



TREATMENT. 



For the patient to " fight the fever " himself by his own will-power 

 is a marked error of judgment, and an unjustifiable risk for the patient 

 to take. 



The indications are : — 



(i) To kill the parasites. 



(2) To aid the excretion of the toxins. 



(3) To relieve the symptoms of the patient. 



Quinine is a specific if the right kind is given and a sufficient 

 quantity used. Quinine is slightly cumulative; the maximum is 

 eliminated in four to twelve hours, nearly all of it in thirty-six hours. 

 It can be recovered from the urine within fifteen minutes from its 

 administration. 



The sulphate is soluble i in 800 of water and must be dissolved in 

 mineral acids. It is the cheapest kind, but is not to be recommended. 

 In the early days of quinine treatment, when the Chinese patients of 

 Sir Patrick Manson passed the quinine given as the sulphate in pills, 

 the pills were collected by Chinese physicians, washed, and sold again 

 to fever patients. 



The hydrochloride is soluble i in 40. 



The bisulphate is soluble i in 11. 



The bihydrochloride is soluble i in i. 



