REMITTENT AND CONTINUED MALARIAL FEVER. 687 



stead of quinine, is antiquated. Besides the administration of quinine 

 or its repetition, we should urge the patient to adopt all the rules 

 spoken of under prophylaxis. When the circumstances of the patients 

 permit, we should have them leave the affected place for six or eight 

 weeks. We have already explained that this does not render the ad- 

 ministration of quinine superfluous. 



If chronic malarial dyscrasia develop, besides a nutritious and 

 strengthening diet, the patient should twice a day take half a glass of 

 bark and wine (tine, cinchonse i, tine, cinnamom. 3 i, acid, sulph. 

 aromat. 3 ij to a bottle of Rhine wine), or three or four teaspoonfuls 

 daily of tine, cinchonas comp., combined with large doses of iron. In 

 most cases the benefit of this treatment is very evident : even advanced 

 dropsy usually disappears in a short time without any diuretic reme- 

 dies ; should it unexpectedly fail, we ought to absolutely insist on a 

 temporary change of residence, even if it be very inconvenient. 



The above treatment is almost always successful in simple inter- 

 mittent. Experiments with substitutes for quinine, such as salacin, 

 piperin, salt, etc., have led to negative or doubtful results. The only 

 febrifuge, except Peruvian bark and its preparations, that deserves con- 

 fidence, is arsenic, in the form of Fowler's solution (four to six drops 

 three times daily during the apyrexia). In view of the far more cer- 

 tain and safe action of quinine, I consider the use of arsenic as only 

 justifiable in those rare cases where quinine fails, even in large doses. 



In pernicious intermittent, our first object is to prevent the occur- 

 rence of the next attack. While carrying out the treatment required 

 by the congestive symptoms during the attack, we should not wait 

 for a complete intermission before giving quinine ; but, as soon as there 

 is the slightest abatement of the symptoms, we should give large doses 

 of quinine (3j to 3 ss. or more), and, if the patients cannot swallow, 

 give it by enema [or, better, by hypodermic injection, giving about 

 one-third the dose by the mouth, perfectly dissolved]. 



In the concealed form of intermittent, quinine is almost as effica- 

 cious as in the simple form ; but even here its action appears only pal- 

 liative and symptomatic, as it does not prevent relapses. 



CHAPTER XII. 



REMITTENT AND CONTINUED MALARIAL FEVER. 



ETIOLOGY. Remittent malarial fevers occur chiefly in the tropics, 

 it is true, but they are occasionally observed among us also, in places 

 where malarial diseases are endemic, and at other places also when 

 epidemics of intermittent are prevailing. Hence I cannot class remit- 



