.MALARIA 10 



:) 



solutions, capsules, cachets, tabloids, tablets, or pills. They may be 

 plain, sugar, or chocolate-coated. The sugar-coated ones are not to 

 be recommended unless they can be used quickly, as the sugar hardens 

 in the tropics and hinders the solution of the drug. In some cases it 

 is useful, as it can be given to patients unknown to them. 



Tablets or tabloids are compact and most useful for work involving 

 much transport. For hospital use the sulphate, dissolved in mineral 

 acids and flavoured, is cheapest. Many tropical residents take 5 grains 

 daily as a prophylactic, or 15 grains (i grm.) twice weekly. 



A regular habit is to be encouraged. 



For malarial attacks, 5-10 and even 20 grains t.d.s. has been 

 taken. Darling recommends heroic does; such were absolutely 

 necessary in the writer's experience when in Colombia. 



One should wait until the temperature has begun to fall before 

 administering the quinine, except in chronic cases, because the head- 

 ache is increased, and the quinine cannot kill the young parasites until 

 the red cells enclosing them are ruptured. 



When headaches and tinnitus aurium are common, pot. brom., 

 5-10 grains, or dilute hydrobromic acid should be administered with 

 each large dose of quinine. 



In old Blackwater cases one should proceed carefully with J-grain 

 doses. 



If the fever is not being mastered, inhalation of amyl nitrite may 

 dislodge the parasites from the capillaries so' that the quinine can get 

 at them. 



Children stand quinine well by the mouth. They must have 

 sufificient, say a child under one year, from J-iJ grains six times daily. 

 A child aged 3-10 years old 2-^ grains six times daily. 



After fever in adults give 15 grains (i grm.) daily for a week, then 

 10 grains for two weeks, followed by 5-10 grains for a month. 



Iron and arsenic should be given. 



In patients with weak hearts digitalis should be given. 



(2) By the rectum. 



Useful in gastric disturbance. One should double the ordinary 

 doses one would give by the mouth, say 20-30 grains, in 10-12 ounces 

 of water or warm saline. The writer when in extremis received 

 40 grains at night, followed by 40 grains the next morning. 



This method is most useful for comatose patients. Use a large 

 catheter attached to a glass syringe or rubber tube with funnel. Give 

 it slowly. 



Continue by the mouth as soon as possible. 



(3) By the muscle. 



Subcutaneous injections should be abandoned. The writer has a 



