1130 PATHOGENS PROTOZOA 



dose may be decreased gradually, beginning a few days after the 

 subsidence of the fever. In exceptional cases a relapse will occur 

 while the patient is still taking massive doses of quinine, and by 

 some this lias been looked upon as an evidence of immunity of the 

 parasite to the drug, but it is possible that it is merely due to non- 

 absorption of the quinine, and carminatives should be added to the 

 dose to assist in its absorption. 



The addition of pepsin to the quinine will reduce the unpleasant 

 effects of the drug. To ninety parts of quinine add 6 parts of 

 lactose and 4 parts of pepsin. 



The proportionate dose required for children is greater than 

 indicated by Cowling's rule. Bass finds that for children of fifteen 

 or over, the full adult dose is necessary. From eleven to fourteen 

 0.8 of the adult dose, from eight to ten 0.6, from five to seven 0.4, 

 for three and four year old children 0.3, two year old 0.2, one 

 year old 0.1 of the adult dose is necessary.* 



In selected cases quinine is occasionally given subcutaneously or 

 intravenously although the method is not free from the risk of 

 abscesses in the subcutaneous tissue, or death after intravenous 

 use. 



For intravenous use a freshly sterilized solution consisting of 

 12 to 15 grains of bihydrochlorid of quinine dissolved in 10 to 20 

 c.c. of normal salt solution can be injected into a vein at the rate of 

 half a c.c. per minute. For subcutaneous use the same quantity of 

 quinine may be used but it must be dissolved in a few cubic centi- 

 meters of fluid. The injection must be given into the loose arcolar 

 tissue but even then it is often painful and apt to be followed by 

 necrosis and abscess. 



Treatment with arsphenamine and related preparations. 



It has been shown that the administration of half doses of the 

 606 group of remedies can be given to selected cases of severe 

 malaria in addition to the usual treatment with quinine, with benefit ; 

 for chronic resistant infections and for malarial cachexia three or 

 four injections at weekly intervals are recommended. The tonic 

 effect of these drugs is quite marked and the duration of illness is 

 shortened by the combined treatment. 



* Pratt- Johnson, ,/., Gilchrist, Kenneth, and Hay-Michel. On the Action of 

 Certain Special Preparations on Malarial Parasites and their Employment in the 

 Treatment of Malaria. 



