58 TROPICAL MEDICINE AND HYGIENE 



5-gr. doses may be given at corresponding intervals 

 in the same manner. If there is any sign of cardiac 

 failure, stimulants, preferably alcoholic, must be freely 

 administered. Every effort must be made to keep the 

 patient alive, as recovery is certain if the quinine has time 

 to act. Hot packs in adults and hot baths in children 

 are beneficial and must be used in addition to quinine. 



The time of giving quinine with reference to fever 

 is not considered to be of so much importance now as 

 it was. The action of the quinine is more decided if 

 it is given when the spores are set free, and therefore 

 in benign tertian and quartan a small dose given before 

 the rigor is more effective than the same dose later. 

 It is in the period immediately before the onset of fever 

 that sporulation occurs and, therefore, when ^quinine acts 

 best ; and there is no advantage in reducing the tempera- 

 ture artificially, as by the use of antipyretics, before giving 

 the quinine, except that vomiting is less likely to ensue 

 and the headache is less. In all cases of malaria, treat- 

 ment with quinine must be continued for a long period 

 after the disappearance of the symptoms. 



A commonly successful practice is to give 10 gr. 

 daily for one week, every other day for two weeks, and 

 twice a week for a month, and 15 gr. once a week for 

 two months. In the majority of cases, even if large 

 doses of quinine have been given during the pyrexial 

 period, relapses will occur unless the use of the drug be 

 persisted in. In the experience of the writer the inter- 

 mittent administration of quinine is not so satisfactory 

 as a regular daily dose of 5 gr. of the hydrochloride of 

 quinine. If given during a meal, say breakfast, the 

 uncoated tabloids can be used. In a few cases of benign 

 tertian a three months' course is not sufficient, but in the 

 vast majority of cases it is in subtertian malaria. 



In malaria there is usually constipation ; this should 

 be relieved, preferably by saline aperients, but calomel 

 and calomel and jalap are used by many. 



Antipyretics, such as phenacetin, are not advisable in 



