TREATMENT IN MALARIAL FEVER 39 



volume of the blood is about 3,000,000 cubic millimetres, 

 it follows that a man might be infected by 600,000,000 

 parasites without having "fever." When the fever is 

 well established the parasites remain in about the same 

 number, showing that only a small proportion of the 

 merozoites formed infect red corpuscles. The birth-rate 

 and death-rate of the " spores" must balance when the 

 parasites remain constant in number. 



Treatment. Quinine in any form and in moderate 

 doses will rapidly relieve the symptoms, but to prevent 

 relapses must be continued in diminished doses for 

 months. The patient should be kept in bed, not only 

 during the pyrexial period, but in the intervals, for two 

 or three days after a pyrexial attack. Quinine is far more 

 effective in a person kept at a uniform temperature in 

 bed and on light diet. The bowels must be kept open. 

 Simple rest and diet will often, without any medicine, 

 cause temporary disappearance of the symptoms if the 

 bowels are kept free. No reliance can be placed on this 

 apparent recovery, as relapse will occur even if the patient 

 is kept in bed. 



The effect of the quinine, either directly or indirectly, 

 is to reduce the number of parasites, but it takes some 

 days to reduce them so much that they cannot be found 

 after a protracted search. 



