MALARIAL FEVER DURING THE PL'ERPERIUM. 195 



improved; she had slept well, the headache was gone, and her temperature and 

 pulse were normal. The swelling of the perineum was much less marked and 

 the lochia were not offensive. 



I then questioned her as to her illness and she informed me that the fever had 

 commenced suddenly with an attack of shivering on the 25th of the month. On 

 the 26th labor pains set in, and the child was bom at 3 a. m. on the 27th. A 

 military doctor had seen her and immediately ordered her removal to Hongkong. 



This necessitated her traveling by a launch for over an hour, and then being 

 transferred on a stretcher to the Victoria Hospital, some 1,000 feet above the 

 sea level. Naturally, she arrived in a somewhat collapsed condition, but soon 

 rallied on being placed in a warm bed and after being given some stimulant. The 

 pain she described in her right side was evidently muscular. 



On examining her blood on the morning of the 28th, I found it to be swarm- 

 ing with benign tertian parasites. She was given 0.3 gram (5 grains) of quinine 

 every four hours, together with an effervescing mixture containing 4 minims of 

 dilute hydrocyanic acid to help her to retain the drug. As the swelling of the 

 perineum had subsided, T removed several small sloughs and inserted a deep silk- 

 worm suture under cocaine anaesthesia. Her temperature did not rise again to 

 37.8°C. (100°F.), and she made an uninterrupted recovery. On January 3 she 

 was discharged from the hospital quite well, accompanied by her baby, who then 

 weighed 3 kilos (GJ pounds). 



Both these cases might have caused considerable anxiety to the 

 medical attendant had they not occured in a malarial country where 

 the physician was alert for this complication. So much does malaria 

 complicate practically all illnesses in Hongkong, especially in the hot 

 summer months, that it is a rule with us to give parturient cases quinine 

 whenever there is the smallest rise of temperature after labor. The 

 practical question must also be considered of how far one is justified 

 in giving quinine daily as a prophylactic to women during the period 

 of pregnancy. Many physicians are chary of doing so, as they think 

 it may from its ecbolic action on the uterus induce abortion or pre- 

 mature labor. In my opinion, it is malarial fever that is more likely 

 to produce that effect, and I am in the habit of always advising the 

 daily dose of 0.130 gram (2 grains) during the summer months, especially 

 to pregnant women whom I have known to have been subject to attacks 

 of malarial fever. 



The following is quoted from Dr. Albert H. Smith : 4 



Quinine has no power in itself to excite uterine contractions, but simply acts 

 as a general stimulant and promoter of vital energy and functional activity. 

 In normal labors at full term, its administration in a dose of 15 grains is usually 

 followed in as many minutes by a decided increase in the force and frequency of 

 the uterine contractions, changing in some instances a tedious exhausting labor 

 into one of rapid energy, advancing to an early completion. 



Quinine promotes the permanent tonic contraction of the uterus, 

 after the expulsion of the placenta. Women that had flooded in former 

 labors escaped entirely, there not having been one instance of post- 



' Trans. Coll. Phys. Philadelphia (1875), 183. 



