ADMINISTRATION OF QUININE IN MALARIAL FEVER 63 



Semple has shown, already present in the patient. The 

 risk does not occur where strict antiseptic precautions 

 are taken. The skin at the point of injection must be 

 cleaned and thoroughly washed with antiseptics, alcohol 

 and ether, and i in 20 carbolic acid, 2 per cent, lysol, or 

 acetone, followed by 2-J- per cent, solution of tinct. of 

 iodine, which is the best. The syringe must be sterilized 

 by boiling, and the solution of quinine must be sterilized 

 in the same way immediately before use. It is sometimes 

 objected that it is the adult and more than half-grown 

 parasites which cause the change in the corpuscles, and 

 that these parasites are not amenable to the action of 

 quinine. No doubt this is so to some extent ; but it 

 must be remembered that quinine has an action on para- 

 sites enclosed in red corpuscles ; and secondly, that as the 

 parasites sporulate that portion of the block due to that 

 corpuscle gives way, so that unless the corpuscles causing 

 the stasis are continually reinforced by fresh corpuscles 

 containing more or less half-grown parasites the circula- 

 tion will be restored. In practice, by giving large doses 

 of quinine repeatedly the mortality is not very large, 

 often three or four cases will be treated in the same 

 ward without any deaths. Cases do die, but usually 

 within two to four hours of admission. If they live 

 more than four hours deaths are exceptional. 



Synthetic antipyretics, such as antipyrin and phenacetin, 

 give relief, but should only be used on patients who are 

 in bed and in mild cases. They may, in severe cases, 

 be the cause of fatal collapse. On the whole their use 

 is to be deprecated. In comatose cases, in addition to 

 the free use of quinine, alcoholic stimulants are required. 

 The use of a cardiac stimulant which acts also as a 

 vasomotor dilator, such as alcohol, is far better than 

 strychnine or digitalis. 



Hot packs in adults and hot baths, with a little 

 mustard in them, in children are of great value in the 

 comatose or convulsive cases. 



Food. Little food can be taken during a sharp pyrexial 



