TREATMENT IN MALARIAL FEVER 



53 



and the broad rounded edge of the organ. It is not 

 necessarily much above the average weight when death 

 occurs early in the course of the disease, and then it 

 usually weighs 10 to 15 oz., rarely more in an adult. 



Examined microscopically malarial pigment is always 

 found, but in early cases the spleen to the naked eye 

 may appear red ; the dense black colour sometimes seen 

 is found in chronic cases, and may be only the remnant 

 of malaria previously contracted. 



The liver also is pigmented, and the pigment is 

 deposited mainly in the cells between the lobules, so 

 much so that in some cases the outlines of the lobules 

 appear to be pencilled out in black. 



Treatment. Many drugs have been employed, quinine, 

 methylene blue, arsenic, opium, &c., but of these only 

 the first two have a marked effect on the parasites. Though 

 the inorganic compounds of arsenic have little effect on 

 the parasites the organic compounds, such as atoxyl, 

 soamin and salvarsan, have a marked effect and may be 

 of value in the rare cases where the parasites are quinine 

 resistent. Since the general adoption of blood examina- 

 tion has led to a sure diagnosis, the value of quinine in 

 malaria has been fully confirmed. 



Any of the salts of quinine may be used. The ethyl 

 carbonate, euquinine, has the great advantage of being 

 tasteless, and is used for children and such adults as have 

 great distaste for quinine. It is too expensive for general 

 use. 



