ii88 



THE MALARIAL FEVRRS 



affection is able to iie dormant for months and years, even after 

 the tropics and any source of infection have been parted with 

 entirely. At times one may be lucky enough to catch all the para- 

 sites sporulating, and to kill them with one large and properly 

 applied dose of quinine. This has certainly happened to us with 

 regard to the subtertian parasite in certain cases, but it may have 

 been accidental. The infection may remain dormant for years, and 

 be reawakened by any cause lowering the resisting powers of the 

 individual, such as a chill, a traumatism, or an operation. In 

 temperate climates there is often a seasonal dormancy in winter. 



TREATMENT. 



Essential Treatment. — There is one specific remedy for malaria, 

 and this is Quinine, which should be given immediately upon the 

 diagnosis of malaria being made, and may be administered as^ 

 follows: — 



A. When the Patient is First seen in an Acute Attack. 



I. In Benign Intermittent Fevers (Quartan and Simple Tertian) 

 give quinine in solution by the mouth, if the patient is not sick, in 

 10 grain doses three times a day, or in doses of 15 grains in the 

 morning and 15 grains in the evening. 



In a certain number of cases it is advisable to give with each dose 

 of quinine 5 grains of sodium bromide in solution, in order to combat 

 any nerve effects of the drug. The bowels should be freely opened 

 with calomel, followed by salines. 



If the heart is not working properly, caffeine citrate in i to 3 grain 

 doses may also be administered, either by the mouth or hypo- 

 dermically. 



If this dosage of quinine is found to be insufficient, as judged by 

 the persistence of the symptoms, increase it to 10 grains every 

 four hours instead of three times a day. 



II. In Severe Intermittent, Remittent, and All Subtertian Fevers 

 give quinine by intramuscular injection in a dose of 15 grains as 

 soon as the diagnosis is made. Repeat the injection daily, and in 

 addition administer the drug by the mouth in 10 grain doses three 

 times a day. 



In these fevers as much as 45-60 grains of quinine may be re- 

 quired in twenty-four hours to combat the symptoms, and should 

 be given by a combination of intramuscular injections with oral 

 administration. 



Sodium bromide, the purgative and cardiac drugs mentioned 

 in the preceding section, may also be given. 



The injection is to be made in a thoroughly antiseptic manner. Use a vial, 

 containing 15 grains of quinine bihydrochloride ini cubic centimetre of fluid, 

 manufactured by some reputable firm. The injection may be made deep 

 into the muscles of the gluteal region, care being taken to avoid the line of the 

 sciatic nerve, or deep into the loose tissue, extending from the lower angle of 

 the scapula to the crest of the ilium. The vials made by different firms vary 



