COMPLICATIONS IN MALARIAL FEVER 67 



commenced the patient need not be confined to bed or 

 even to the house, but quinine must be continued for 

 many months. Under such treatment the anaemic con- 

 dition rapidly improves, but can be expedited by adminis- 

 tration of small doses of arsenic or of iron and arsenic 

 by the mouth, or, better, by intramuscular injection. 

 Such mixtures as Easton's syrup in i-dr. doses will 

 often be found useful. Cold " bracing " climates should 

 be avoided at first, the warmer " relaxing " climates are 

 more suitable. Later, dry bracing climates, such as the 

 Swiss winter resorts, or Harrogate in the summer, are 

 distinctly beneficial. 



If the weather be suitable when convalescence is well 

 established, as much time as possible should be spent in 

 the open air, and exercise, not of a violent character and 

 always short of fatigue, should be encouraged. 



The enlargement of the spleen at first subsides rapidly, 

 but some enlargement will persist for many months. 

 Soamin, in 5-gr. doses intramuscularly, is advocated by 

 some. Pierpont and Acton give full doses on six alternate 

 days, and claim excellent results. It is important to be 

 certain of the diagnosis ; some of the milder cases of 

 supposed malarial cachexia are the result of too prolonged 

 unnecessary administration of quinine, and the symptoms 

 will rapidly cease when quinine is discontinued. 



Ill-effects of prolonged use of quinine are not uncom- 

 mon. The ordinary effects of quinine buzzing in the 

 ears, dizziness, and so on are not usually met with in 

 persons who habitually take quinine. The main effects 

 are chronic, atonic dyspepsia and its sequelae, and ner- 

 vous depression or irritability. Too large doses may 

 cause permanent deafness, but this is rare ; more com- 

 monly gradual but complete recovery takes place. 



Amblyopia may occur. The onset is usually sudden, 

 and both eyes are affected. The pupils are dilated and 

 do not react to light. The disc is pale, there is a white 

 haze over the fundus, and the vessels are constricted. 

 Vision is lost completely for a time, but as a rule there 



